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Gedik B, Yuksel O, Kazim Erol M, Duman F, Dogan B, Suren E, Yavuz S. Evaluation of the retina, choroid and optic disc vascular structures in individuals with a history of COVID-19. J Fr Ophtalmol 2024; 47:104014. [PMID: 37925322 DOI: 10.1016/j.jfo.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION In this study, we aimed to detect changes in posterior segment structures and vascular density caused by COVID-19 using an optical coherence tomography angiography (OCTA) device. MATERIALS AND METHODS The study included 20 eyes of 20 patients no systemic or ocular disease who were followed at the Ophthalmology Clinic of Health Sciences University Antalya Training and Research Hospital. The OCTA images of these individuals taken prior to contracting COVID-19 and six months after recovery were examined. RESULTS The mean choriocapillaris blood flow was 2.00±0.13mm2 before COVID-19 and 2.08±0.23mm2 after the disease, and the mean subfoveal choroidal thickness was 247.33±7.65μm before the disease and 273.08±4.92μm after the disease, indicating a statistically significant difference (P=0.003, P=0.001, respectively). The mean retinal nerve fiber layer thickness before and after COVID-19 were 119.33±3.88 and 117.50±3.92μm, respectively, representing a statistically significant decrease (P<0.001). CONCLUSION This is the first study in the literature to evaluate the post-COVID-19 changes in the vascular structures of the eye compared to the pre-disease values. In this study, we found statistically significant changes in choriocapillaris blood flow, subfoveal chroidal thickness and retinal nerve fiber layer thickness after COVID-19 infection. Further research with a greater sample size is needed to explore the effect of COVID-19 on these parameters.
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Affiliation(s)
- B Gedik
- Department of Ophthalmology, Antalya Serik State Hospital, Serik, Antalya 07500, Turkey.
| | - O Yuksel
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - M Kazim Erol
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - F Duman
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - B Dogan
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - E Suren
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - S Yavuz
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
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2
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Tocoglu AG, Dogan B, Tuzun S, Akcay EU, Altas AE, Ayhan LT, Yilmaz S, Genc AC, Gonullu E, Tamer A. The relationship between Salusin-α, Salusin-β, and Klotho levels with subclinical atherosclerosis in ankylosing spondylitis. Eur Rev Med Pharmacol Sci 2023; 27:9838-9845. [PMID: 37916350 DOI: 10.26355/eurrev_202310_34160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Subclinical atherosclerosis (SA) is often observed in ankylosing spondylitis (AS) patients; Salusin-α (Sal-α), Salusin-β (Sal-β), and Klotho hormones are thought to be associated with atherosclerosis. This study aims to evaluate the relationship between Sal-α, Sal-β, and Klotho levels with SA in AS. PATIENTS AND METHODS The study included patients older than 18 years who applied between August 1, 2019, and September 1, 2019. Patients with AS were included in the AS group, and patients without a known disease were included in the healthy group. Epicardial adipose tissue thickness (EATT) and carotid intima-media thickness (CIMT) measurements were used to assess SA. RESULTS The study group included 38 (40.9%) patients diagnosed with AS, and the control group included 55 (59.1%) participants. CIMT and EATT levels were higher in the AS group than in the healthy group [0.37 (0.17) vs. 0.54±0.18, p<0.001; 0.44±0.11 vs. 0.54 (0.18), p=0.004, respectively]. There was no significant difference in Sal-α, Sal-β, and Klotho levels between the AS and healthy groups (p>0.05). Furthermore, there was no observed relationship between EATT or CIMT and Klotho, Sal-α, or Sal-β in either group (p>0.05). CONCLUSIONS Although SA level was higher in AS patients, there was no relationship between SA and Sal-α, Sal-β, and Klotho levels.
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Affiliation(s)
- A G Tocoglu
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey.
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Dogan B, Eren M, Abamor E, Yetmen Dogan O. 9P The survival effect and prognostic factors of residual tumor confined to the uterus after radical radio-chemotherapy in cervical cancer. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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4
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Yildiz AS, Ustundag FD, Tiber PM, Dogan B. The relationship between vitamin D receptor gene polymorphisms and periodontitis in turkish individuals with type 2 diabetes mellitus. Niger J Clin Pract 2022; 25:1163-1172. [PMID: 35859479 DOI: 10.4103/njcp.njcp_1894_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Aim Vitamin D receptor (VDR) gene polymorphisms have been implicated in the pathogenesis of many diseases, such as periodontitis and diabetes mellitus (DM). The present study aimed to evaluate the distributions of VDR polymorphisms in diabetic individuals with healthy periodontium (DMH), diabetic individuals with periodontitis (DMP), nondiabetic individuals with healthy periodontium (H), and nondiabetic individuals with periodontitis (P). Material and Methods A total of 200 individuals (DMH = 40, DMP = 60, H = 40, and P = 60) were recruited. All clinical periodontal parameters, demographical, and biochemical variables were recorded. Blood samples were collected, and genomic DNA was isolated by Purelink® Genomic DNA Mini Kit. Genotyping of VDR polymorphisms ApaI, BsmI, FokI, and TaqI were determined by real-time polymerase chain reaction (PCR) using allele-specific probes. Results The distribution of the BsmI variant showed differences between DMH and H groups (P = 0.034). In addition, carrying the GG genotype (OR = 0.317; 95% CI = 0.126-0.797; P = 0.013) and the G allele (OR = 2.373; 95% CI = 1.203-4.681; P = 0.012) increased the risk of type 2 DM. Moreover, it was determined that the frequency of CC genotype of FokI variant was higher in DMP compared to DMH (P = 0.046). It was determined that having the CC genotype (OR = 2.706; 95% CI = 1.185-6.176; P = 0.017) and the C allele (OR = 1.917; 95% CI = 0.995-3.694; P = 0.049) increased the risk of periodontitis among diabetic individuals. No differences were detected among groups in the genotype and allele distributions of ApaI and TaqI variants (P > 0.05). Conclusions The present study showed that the BsmI variant was a risk factor for DM among periodontally healthy individuals and the FokI variant for periodontitis among diabetic individuals.
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Affiliation(s)
- A Saatman Yildiz
- Department of Periodontology, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - F D Ustundag
- Department of Biophysics, Institute of Health Sciences, Istanbul, Turkey
| | - P Mega Tiber
- Department of Biophysics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - B Dogan
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Piskinpasa H, Dogansen S, Metin D, Gumusoglu A, Altinay S, Sipahi M, Dogan B, Apaydin S. IS THERE A RELATIONSHIP BETWEEN TUBEROUS SCLEROSIS COMPLEX AND INSULINOMA? Acta Endocrinol (Buchar) 2022; 18:350-354. [PMID: 36699161 PMCID: PMC9867813 DOI: 10.4183/aeb.2022.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disease characterized by multiple hamartomas in multiple organs. However, there is limited evidence about neuroendocrine tumors (NETs) in patients with TSC, and routine screening of NETs is not recommended in the guidelines. Insulinomas are also an extremely rare disease. According to our knowledge, we presented the 10th TSC patient diagnosed with insulinoma in the literature. Thirty-two years old male patient diagnosed with TSC at the age of 27 due to typical skin findings, renal angiomyolipoma, history of infantile seizures, and cranial involvement was referred to our clinic. The main symptoms of the patient were palpitations, diaphoresis, confusion, and symptoms were improved after consuming sugary foods. Seventy-two hours fasting test was performed, and a low glucose level at 41 mg/dl, a high insülin level at 21.65 µIU/mL, and a high C-peptide level at 7.04 ng/mL were found at the 8th hour. In addition, a 12x7 mm lesion in the pancreatic tail was detected in abdominal imaging. Ga-68 PET-CT (gallium-68 positron emission tomography-computed tomography) detected an increased uptake of Ga-68 in the pancreatic tail. The patient underwent distal pancreatectomy, and pathological evaluation was consistent with an insulinoma. The patient's symptoms improved postoperatively. Since in nearly all TSC cases, as in our case, neuropsychiatric abnormalities, such as epilepsy, are one of the main disease manifestations, and these symptoms may be confused with the clinical manifestations of hypoglycemia in insulinoma. Therefore, patients with newly developed neurological symptoms and behavioral defects should be evaluated in terms of insulinoma.
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Affiliation(s)
- H. Piskinpasa
- Dept. of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - S.C. Dogansen
- Dept. of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - D. Metin
- Dept. of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - A.Y. Gumusoglu
- Dept. of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - S. Altinay
- Dept. of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - M. Sipahi
- Dept. of Nuclear Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - B. Dogan
- Dept. of Internal Medicine,, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - S. Apaydin
- Yeditepe University Kosuyolu Hospital, Dept. of Nephrology, Istanbul, Turkey
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Merchant K, Omar L, Hayes J, Compton L, Polat D, Xi Y, Dogan B. ACR BI-RADS Category 3 Lesions in Women Younger Than 30: Follow-up Outcomes and Factors Associated With Biopsy. J Ultrasound Med 2021; 40:2699-2707. [PMID: 33599304 DOI: 10.1002/jum.15660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years. METHODS We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed. RESULTS Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up. CONCLUSIONS BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months.
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Affiliation(s)
| | - Lena Omar
- Radiology, UT Southwestern, Dallas, Texas, USA
| | - Jody Hayes
- Radiology, UT Southwestern, Dallas, Texas, USA
| | | | - Dogan Polat
- Radiology, UT Southwestern, Dallas, Texas, USA
| | - Yin Xi
- Radiology, UT Southwestern, Dallas, Texas, USA
| | - Basak Dogan
- Diagnostic Radiology, The UT Southwestern Medical Center, Dallas, Texas, USA
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Dialani V, Dogan B, Dodelzon K, Dontchos BN, Modi N, Grimm L. Axillary Imaging Following a New Invasive Breast Cancer Diagnosis-A Radiologist's Dilemma. J Breast Imaging 2021; 3:645-658. [PMID: 38424939 DOI: 10.1093/jbi/wbab082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 03/02/2024]
Abstract
Traditionally, patients with newly diagnosed invasive breast cancer underwent axillary US to assess for suspicious axillary lymph nodes (LNs), which were then targeted for image-guided needle biopsy to determine the presence of metastasis. Over the past decade, there has been a shift towards axillary preservation. For patients with palpable lymphadenopathy, the decision to perform axillary imaging with documentation of the number and location of abnormal LNs in preparation for image-guided LN sampling is straightforward. Since LN involvement correlates with cancer size, it is reasonable to image the axilla in patients with tumors larger than 5 cm; however, for tumors smaller than 5 cm, axillary imaging is often deferred until after the tumor molecular subtype and treatment plan are established. Over the last decade, neoadjuvant chemotherapy (NACT) is increasingly used for smaller cancers with more aggressive molecular subtypes. In most cases, detecting axillary metastasis is critical when deciding whether the patient would benefit from NACT. There is increasing evidence that abnormal axillary US findings correlates with LN metastases and reliably establishes a baseline to monitor response to NACT. Depending on hormone receptor status, practices may choose to image the axilla in the setting of clinical stage T1 and T2 cancers to evaluate nodal status and help determine further steps in care. Radiologists should understand the nuances of axillary management and the scope and challenges of LN marking techniques that significantly increase the precision of limited axillary surgery.
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Affiliation(s)
- Vandana Dialani
- Beth Israel Lahey Hospital, Department of Radiology, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Basak Dogan
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Katerina Dodelzon
- Weill Cornell Medical College, Department of Radiology, New York, NY, USA
| | - Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Neha Modi
- Saint Vincent Hospital at Worcester Medical Center, Department of Radiology, Worcester, MA, USA
| | - Lars Grimm
- Duke University Hospital, Department of Radiology, Durham, NC, USA
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8
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Onishi N, Li W, Newitt DC, Harnish RJ, Strand F, Nguyen AAT, Arasu VA, Gibbs J, Jones EF, Wilmes LJ, Kornak J, Joe BN, Price ER, Ojeda-Fournier H, Eghtedari M, Zamora KW, Woodard S, Umphrey HR, Nelson MT, Church AL, Bolan PJ, Kuritza T, Ward K, Morley K, Wolverton D, Fountain K, Lopez Paniagua D, Hardesty L, Brandt KR, McDonald ES, Rosen M, Kontos D, Abe H, Sheth D, Crane E, Dillis C, Sheth P, Hovanessian-Larsen L, Bang DH, Porter B, Oh KY, Jafarian N, Tudorica LA, Niell B, Drukteinis J, Newell MS, Giurescu ME, Berman E, Lehman CD, Partridge SC, Fitzpatrick KA, Borders MH, Yang WT, Dogan B, Goudreau SH, Chenevert T, Yau C, DeMichele A, Berry DA, Esserman LJ, Hylton NM. Breast MRI during Neoadjuvant Chemotherapy: Lack of Background Parenchymal Enhancement Suppression and Inferior Treatment Response. Radiology 2021; 301:295-308. [PMID: 34427465 PMCID: PMC8574064 DOI: 10.1148/radiol.2021203645] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/01/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2023]
Abstract
Background Suppression of background parenchymal enhancement (BPE) is commonly observed after neoadjuvant chemotherapy (NAC) at contrast-enhanced breast MRI. It was hypothesized that nonsuppressed BPE may be associated with inferior response to NAC. Purpose To investigate the relationship between lack of BPE suppression and pathologic response. Materials and Methods A retrospective review was performed for women with menopausal status data who were treated for breast cancer by one of 10 drug arms (standard NAC with or without experimental agents) between May 2010 and November 2016 in the Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging and Molecular Analysis 2, or I-SPY 2 TRIAL (NCT01042379). Patients underwent MRI at four points: before treatment (T0), early treatment (T1), interregimen (T2), and before surgery (T3). BPE was quantitatively measured by using automated fibroglandular tissue segmentation. To test the hypothesis effectively, a subset of examinations with BPE with high-quality segmentation was selected. BPE change from T0 was defined as suppressed or nonsuppressed for each point. The Fisher exact test and the Z tests of proportions with Yates continuity correction were used to examine the relationship between BPE suppression and pathologic complete response (pCR) in hormone receptor (HR)-positive and HR-negative cohorts. Results A total of 3528 MRI scans from 882 patients (mean age, 48 years ± 10 [standard deviation]) were reviewed and the subset of patients with high-quality BPE segmentation was determined (T1, 433 patients; T2, 396 patients; T3, 380 patients). In the HR-positive cohort, an association between lack of BPE suppression and lower pCR rate was detected at T2 (nonsuppressed vs suppressed, 11.8% [six of 51] vs 28.9% [50 of 173]; difference, 17.1% [95% CI: 4.7, 29.5]; P = .02) and T3 (nonsuppressed vs suppressed, 5.3% [two of 38] vs 27.4% [48 of 175]; difference, 22.2% [95% CI: 10.9, 33.5]; P = .003). In the HR-negative cohort, patients with nonsuppressed BPE had lower estimated pCR rate at all points, but the P values for the association were all greater than .05. Conclusions In hormone receptor-positive breast cancer, lack of background parenchymal enhancement suppression may indicate inferior treatment response. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Philpotts in this issue.
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Affiliation(s)
- Natsuko Onishi
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Wen Li
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - David C. Newitt
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Roy J. Harnish
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Fredrik Strand
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Alex Anh-Tu Nguyen
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Vignesh Amal Arasu
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Jessica Gibbs
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Ella F. Jones
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Lisa J. Wilmes
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - John Kornak
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Bonnie N. Joe
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Elissa R. Price
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Haydee Ojeda-Fournier
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Mohammad Eghtedari
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Kathryn W. Zamora
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Stefanie Woodard
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Heidi R. Umphrey
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Michael T. Nelson
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - An L. Church
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Patrick J. Bolan
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Theresa Kuritza
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Kathleen Ward
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Kevin Morley
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Dulcy Wolverton
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Kelly Fountain
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Dan Lopez Paniagua
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Lara Hardesty
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Kathleen R. Brandt
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Elizabeth S. McDonald
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Mark Rosen
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Despina Kontos
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Hiroyuki Abe
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Deepa Sheth
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Erin Crane
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Charlotte Dillis
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Pulin Sheth
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Linda Hovanessian-Larsen
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Dae Hee Bang
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Bruce Porter
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Karen Y. Oh
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Neda Jafarian
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Luminita A. Tudorica
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Bethany Niell
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Jennifer Drukteinis
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Mary S. Newell
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Marina E. Giurescu
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Elise Berman
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Constance D. Lehman
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Savannah C. Partridge
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Kimberly A. Fitzpatrick
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Marisa H. Borders
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Wei Tse Yang
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Basak Dogan
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Sally Hayward Goudreau
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Thomas Chenevert
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Christina Yau
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Angela DeMichele
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Donald A. Berry
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Laura J. Esserman
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
| | - Nola M. Hylton
- Author affiliations: From the Department of Radiology
& Biomedical Imaging, University of California San Francisco, 1600
Divisadero St, Room C255, San Francisco, CA 94115 (N.O., W.L., D.C.N., R.J.H.,
F.S., A.A.T.N., V.A.A., J.G., E.F.J., L.J.W., B.N.J., E.R.P., N.M.H.);
Department of Breast Radiology, Karolinska University Hospital, Solna,
Stockholm, Sweden (F.S.); Department of Radiology, Kaiser Permanente Vallejo
Medical Center, Vallejo, Calif (V.A.A.); Department of Epidemiology and
Biostatistics, University of California San Francisco, San Francisco, Calif
(J.K.); Department of Radiology, University of California San Diego, La Jolla,
Calif (H.O.F., M.E.); Department of Radiology, The University of Alabama at
Birmingham, Birmingham, Ala (K.W.Z., S.W., H.R.U.); Department of Radiology,
University of Minnesota, Minneapolis, Minn (M.T.N., A.L.C., P.J.B.); Department
of Radiology, Loyola Medicine, Maywood, Ill (T.K., K.W., K.M.); Department of
Radiology, University of Colorado Denver, Denver, Colo (D.W., K.F., D.L.P.,
L.H.); Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester,
Minn (K.R.B.); Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (E.S.M., M.R., D.K.); Department of Radiology, University of
Chicago Medical Center, Chicago, Ill (H.A., D.S.); Department of Radiology,
Georgetown University, Washington, DC (E.C., C.D.); Department of Radiology,
University of Southern California, Los Angeles, Calif (P.S., L.H.L.); Department
of Radiology, Swedish Cancer Institute, Seattle, Wash (D.H.B., B.P.); Department
of Radiology, Oregon Health & Science University, Portland, Ore (K.Y.O.,
N.J., L.A.T.); Department of Radiology, Moffitt Cancer Center, Tampa, Fla (B.N.,
J.D.); Department of Women’s Imaging, St. Joseph’s Women’s
Hospital, Tampa, Fla (J.D.); Department of Radiology, Emory University, Atlanta,
Ga (M.S.N.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
(M.E.G.); Department of Radiology, Inova Health System, Fairfax, Va (E.B.);
Department of Radiology, Harvard Medical School, Massachusetts General Hospital,
Boston, Mass (C.D.L.); Department of Radiology, University of Washington,
Seattle, Wash (S.C.P.); Department of Medical Imaging, Banner University Medical
Center Tucson, Tucson, Ariz (K.A.F., M.H.B.); Department of Radiology,
University of Texas MD Anderson Cancer Center, Houston, Tex (W.T.Y., B.D.);
Department of Radiology, University of Texas Southwestern Medical Center at
Dallas, Dallas, Tex (B.D., S.H.G.); Department of Radiology, University of
Michigan, Ann Arbor, Mich (T.C.); Department of Surgery, University of
California San Francisco, San Francisco, Calif (C.Y., L.J.E.); Department of
Oncology and Hematology, University of Pennsylvania, Philadelphia, Pa (A.D.);
and Berry Consultants, LLC, Austin, Tex (D.A.B.)
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9
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Kaiser SV, Watson A, Dogan B, Karmur A, Warren K, Wang P, Camano Sosa M, Olarte A, Dorsey S, Su M, Brown L, Sachdev D, Bardach NS. Preventing COVID-19 Transmission in Education Settings. Pediatrics 2021; 148:peds.2021-051438. [PMID: 34112660 DOI: 10.1542/peds.2021-051438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In fall 2020, community hubs opened in San Francisco, California, to support vulnerable groups of students in remote learning. Our objectives were to (1) describe adherence to coronavirus disease 2019 (COVID-19) mitigation policies in these urban, low-income educational settings; (2) assess associations between policy adherence and in-hub COVID-19 transmission; and (3) identify barriers to and facilitators of adherence. METHODS We conducted a mixed-methods study from November 2020 to February 2021. We obtained COVID-19 case data from the San Francisco Department of Public Health, conducted field observations to observe adherence to COVID-19 mitigation policies, and surveyed hub leaders about barriers to and facilitators of adherence. We summarized quantitative data using descriptive statistics and qualitative data using thematic content analysis. RESULTS A total of 1738 children were enrolled in 85 hubs (39% Hispanic, 29% Black). We observed 54 hubs (n = 1175 observations of children and 295 observations of adults). There was high community-based COVID-19 incidence (2.9-41.2 cases per 100 000 residents per day), with 36 cases in hubs and only 1 case of hub-based transmission (adult to adult). Sixty-seven percent of children and 99% of adults were masked. Fifty-five percent of children and 48% of adults were distanced ≥6 ft. Facilitators of mitigation policies included the following: for masking, reminders, adequate supplies, and "unmasking zones"; for distancing, reminders and distanced seating. CONCLUSIONS We directly observed COVID-19 mitigation in educational settings, and we found variable adherence. However, with promotion of multiple policies, there was minimal COVID-19 transmission (despite high community incidence). We detail potential strategies for increasing adherence to COVID-19 mitigation.
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Affiliation(s)
- Sunitha V Kaiser
- Philip R. Lee Institute for Health Policy Studies .,Departments of Pediatrics.,Epidemiology and Biostatistics
| | - Annalisa Watson
- Philip R. Lee Institute for Health Policy Studies.,Departments of Pediatrics
| | - Basak Dogan
- Philip R. Lee Institute for Health Policy Studies
| | - Akash Karmur
- Philip R. Lee Institute for Health Policy Studies
| | | | - Phoebe Wang
- Philip R. Lee Institute for Health Policy Studies
| | | | - Apryl Olarte
- Philip R. Lee Institute for Health Policy Studies.,Departments of Pediatrics
| | - Sherrice Dorsey
- San Francisco Department of Children, Youth, and Their Families, San Francisco, California
| | - Maria Su
- San Francisco Department of Children, Youth, and Their Families, San Francisco, California
| | - Lillian Brown
- Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Department of Public Health, San Francisco, California
| | - Darpun Sachdev
- San Francisco Department of Public Health, San Francisco, California
| | - Naomi S Bardach
- Philip R. Lee Institute for Health Policy Studies.,Departments of Pediatrics
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10
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Arjmandi F, Mootz A, Farr D, Reddy S, Dogan B. New horizons in imaging and surgical assessment of breast cancer lymph node metastasis. Breast Cancer Res Treat 2021; 187:311-322. [PMID: 33982209 DOI: 10.1007/s10549-021-06248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/29/2021] [Indexed: 01/09/2023]
Abstract
Axillary nodal status is one of the most important prognostic factors in breast cancer. While sentinel lymph node biopsy (SLNB) is a safe and validated procedure for clinically node-negative patients, axillary management of clinically node-positive patients has been more controversial. Patients with clinically detected axillary metastases often benefit from neoadjuvant chemotherapy (NAC). Those who convert to node-negative disease following NAC are important to identify, since they can often be spared significant morbidity from axillary dissection. SLNB has shown widely varying false-negative rates (FNR) but with the use of dual mapping and surgical biopsy of 3 or more nodes, it is considered an acceptable method to stage the axilla in clinically node-positive patients who receive NAC. Various methods including targeted axillary dissection (TAD) have been shown to decrease the FNR of SLNB. We will review appropriate methods to identify a metastatic node and subsequent ultrasound-guided biopsy with tissue marking techniques. We underscore key points in monitoring axillary response, techniques to accurately localize the biopsied and clipped known metastatic node for surgical excision and the effect of various methods in reducing the FNR of SLNB, including the emerging concept of TAD on patient care.
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Affiliation(s)
- Firouzeh Arjmandi
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8896, USA.
| | - Ann Mootz
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8896, USA
| | - Deborah Farr
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8896, USA
| | - Sangeetha Reddy
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8896, USA
| | - Basak Dogan
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8896, USA
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11
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Dodelzon K, Grimm LJ, Tran K, Dontchos BN, Destounis S, Dialani V, Dogan B, Sonnenblick E, Zuley M, Milch HS. Impact of COVID-19 on Breast Imaging Practice Operations and Recovery Efforts: A North American Study. J Breast Imaging 2021; 3:156-167. [PMID: 38424821 PMCID: PMC7928933 DOI: 10.1093/jbi/wbab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on breast imaging facilities' operations and recovery efforts across North America. METHODS A survey on breast imaging facilities' operations and strategies for recovery during the COVID-19 pandemic was distributed to the membership of the Society of Breast Imaging and National Consortium of Breast Centers from June 4, 2020, to July 14, 2020. A descriptive summary of responses was performed. Comparisons were made between demographic variables of respondents and questions of interest using a Pearson chi-square test. RESULTS There were 473 survey respondents (response rate of 13%). The majority of respondents (70%; 332/473) reported 80%-100% breast imaging volume reduction, with 94% (447/473) reporting postponement of screening mammography. The majority of respondents (97%; 457/473) continued to perform biopsies. There were regional differences in safety measures taken for staff (P = 0.004), with practices in the West more likely reporting no changes in the work environment compared to other regions. The most common changes to patients' experience included spacing out of furniture in waiting rooms (94%; 445/473), limiting visitors (91%; 430/473), and spacing out appointments (83%). A significantly higher proportion of practices in the Northeast (95%; 104/109) initiated patient scheduling changes compared to other regions (P = 0.004). CONCLUSION COVID-19 had an acute impact on breast imaging facilities. Although common national operational patterns emerged, geographic variability was notable in particular in recovery efforts. These findings may inform future best practices for delivering breast imaging care amid the ongoing and geographically shifting COVID-19 pandemic.
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Affiliation(s)
- Katerina Dodelzon
- Weill Cornell at NewYork-Presbyterian, Department of Radiology, New York, NYUSA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Khai Tran
- SutterHealth, Breast Imaging Division, Sacramento, CA, USA
| | - Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Stamatia Destounis
- Elizabeth Wende Breast Care, Department of Radiology, Rochester, NY, USA
| | - Vandana Dialani
- Beth Israel Lahey Health, Department of Radiology, Boston, MA, USA
| | - Basak Dogan
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Emily Sonnenblick
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY, USA
| | - Margarita Zuley
- University of Pittsburgh, Department of Radiology, Pittsburgh, PA, USA
| | - Hannah S Milch
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
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12
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Cochran L, Hill S, Lotti U, Allenspach K, Palma D, Forman M, Gary AT, Dogan B, McDonough SP, Simpson KW. Clinical characteristics and long-term outcome of E. coli-associated granulomatous ileocolitis in dogs: five cases (2010-2014). J Small Anim Pract 2021; 62:588-598. [PMID: 33660270 DOI: 10.1111/jsap.13313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/16/2020] [Accepted: 01/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To describe the clinical characteristics and long-term outcome of Escherichia coli-associated granulomatous ileocolitis in dogs. METHODS Retrospective review of medical records from dogs with periodic acid-Schiff positive (PAS+) granulomatous ileocolitis and mucosally invasive E. coli in the ileum and colon. Initial bacterial colonisation was evaluated using fluorescence in situ hybridization (FISH) in all dogs and corroborated with colonic and/or ileal culture, when performed. RESULTS Four boxer dogs and 1 French Bulldog with PAS+ granulomatous ileocolitis (GIC) were evaluated. All dogs had chronic diarrhoea refractory to empirical therapy. Ileocolonoscopy revealed mucosal haemorrhage and ulceration in the ileum (3/4) and colon (5/5). E. coli were visualised as clusters within the ileal and colonic mucosa. Complete (CR, 4/5) or partial (PR, 1/5) clinical response to fluoroquinolones was noted in all dogs within 30 days. CR was sustained in three of four dogs (median disease-free interval 40 months, range 16 to 60). Two dogs relapsed while receiving fluoroquinolones. Repeat biopsy isolated multidrug-resistant, mucosally invasive E. coli in the ileum (1/2) and colon (2/2). Targeted antimicrobial therapy was associated with long-term PR (78 months) in both dogs. CLINICAL SIGNIFICANCE Concurrent E. coli-associated granulomatous inflammation in the ileum and colon did not impart a poor clinical outcome or lack of response to the conventional standard of care for granulomatous colitis in dogs that were aggressively diagnosed and treated. Clinical outcome was influenced by antimicrobial resistance, with response dependent upon antimicrobial therapy informed by susceptibility testing.
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Affiliation(s)
- L Cochran
- Department of Internal Medicine, Veterinary Specialty Hospital of San Diego by Ethos, San Diego, California, 92121, USA
| | - S Hill
- Department of Internal Medicine, Veterinary Specialty Hospital of San Diego, San Diego, California, 92121, USA
| | - U Lotti
- Clinica Veterinaria Valdinievole Srl, Via Costantino Nigra, Monsummano Terme (PT), Italy
| | - K Allenspach
- Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, Ames, Iowa, 50011-1134, USA.,Department of Veterinary Clinical Sciences and Services, Royal Veterinary College, University of London, Hawshead Lane, North Mymms, Hatfield, AL9 7TA, UK
| | - D Palma
- Department of Internal Medicine, Animal Medical Center, New York, New York, 10065, USA
| | - M Forman
- Department of Internal Medicine, Cornell University Veterinary Specialists, Stamford, Connecticut, 06902, USA
| | - A T Gary
- Arkansas Veterinary Internal Medicine, 2150 Bypass Road, Heber Springs, Arkansas, 72543, USA
| | - B Dogan
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, New York, 14853, USA
| | - S P McDonough
- Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, T8 008A Veterinary Research Tower, Box 17 Ithaca, New York, 14853-6401, USA
| | - K W Simpson
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, New York, 14853, USA
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Dogan B, Kaan D, Ulger H. The effect of growth factors on induction of mesenchymal stem cell to the skeletal muscle cells. ACTA ACUST UNITED AC 2020; 121:853-857. [PMID: 33300353 DOI: 10.4149/bll_2020_140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of IGF1 and FGF2 growth factors on the differentiation of human adipose tissue‑derived mesenchymal stem cells (MSCs) into skeletal muscle cells. METHODS MSCs were divided into four groups. Group I (control group) was incubated only in myogenic medium, group II was incubated by adding 100 ng/ml FGF2 to the myogenic medium, group III was incubated by adding 20 ng/ml IGF1 to the myogenic medium, group IV was incubated by adding 100 ng/ml FGF2 and 20 ng/ml IGF1 to the myogenic medium. Cells dyed with MyoD1 antibodies were analyzed by flow cytometry so as to determine the myogenic differentiation on day 28. RESULTS It was confirmed that 11.5 % of the control group, 39.2 % of the FGF2 group, 23.1 % of the IGF1 group, and 39.3 % of the IGF1-FGF2 group showed differentiation. CONCLUSION Our results show that IGF1 and FGF2 have a positive contribution to myogenic differentiation of MSCs. They contribute to the studies related to muscle diseases and their treatment by the fact that growth factors support the feature of regeneration capacity and differentiation (Tab. 2, Fig. 7, Ref. 23).
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Li W, Newitt DC, Gibbs J, Wilmes LJ, Jones EF, Arasu VA, Strand F, Onishi N, Nguyen AAT, Kornak J, Joe BN, Price ER, Ojeda-Fournier H, Eghtedari M, Zamora KW, Woodard SA, Umphrey H, Bernreuter W, Nelson M, Church AL, Bolan P, Kuritza T, Ward K, Morley K, Wolverton D, Fountain K, Lopez-Paniagua D, Hardesty L, Brandt K, McDonald ES, Rosen M, Kontos D, Abe H, Sheth D, Crane EP, Dillis C, Sheth P, Hovanessian-Larsen L, Bang DH, Porter B, Oh KY, Jafarian N, Tudorica A, Niell BL, Drukteinis J, Newell MS, Cohen MA, Giurescu M, Berman E, Lehman C, Partridge SC, Fitzpatrick KA, Borders MH, Yang WT, Dogan B, Goudreau S, Chenevert T, Yau C, DeMichele A, Berry D, Esserman LJ, Hylton NM. Predicting breast cancer response to neoadjuvant treatment using multi-feature MRI: results from the I-SPY 2 TRIAL. NPJ Breast Cancer 2020; 6:63. [PMID: 33298938 PMCID: PMC7695723 DOI: 10.1038/s41523-020-00203-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Dynamic contrast-enhanced (DCE) MRI provides both morphological and functional information regarding breast tumor response to neoadjuvant chemotherapy (NAC). The purpose of this retrospective study is to test if prediction models combining multiple MRI features outperform models with single features. Four features were quantitatively calculated in each MRI exam: functional tumor volume, longest diameter, sphericity, and contralateral background parenchymal enhancement. Logistic regression analysis was used to study the relationship between MRI variables and pathologic complete response (pCR). Predictive performance was estimated using the area under the receiver operating characteristic curve (AUC). The full cohort was stratified by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status (positive or negative). A total of 384 patients (median age: 49 y/o) were included. Results showed analysis with combined features achieved higher AUCs than analysis with any feature alone. AUCs estimated for the combined versus highest AUCs among single features were 0.81 (95% confidence interval [CI]: 0.76, 0.86) versus 0.79 (95% CI: 0.73, 0.85) in the full cohort, 0.83 (95% CI: 0.77, 0.92) versus 0.73 (95% CI: 0.61, 0.84) in HR-positive/HER2-negative, 0.88 (95% CI: 0.79, 0.97) versus 0.78 (95% CI: 0.63, 0.89) in HR-positive/HER2-positive, 0.83 (95% CI not available) versus 0.75 (95% CI: 0.46, 0.81) in HR-negative/HER2-positive, and 0.82 (95% CI: 0.74, 0.91) versus 0.75 (95% CI: 0.64, 0.83) in triple negatives. Multi-feature MRI analysis improved pCR prediction over analysis of any individual feature that we examined. Additionally, the improvements in prediction were more notable when analysis was conducted according to cancer subtype.
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Affiliation(s)
- Wen Li
- University of California, San Francisco, CA, USA
| | | | | | | | - Ella F Jones
- University of California, San Francisco, CA, USA
| | | | - Fredrik Strand
- University of California, San Francisco, CA, USA
- Karolinska Institute, Stockholm, Sweden
| | | | | | - John Kornak
- University of California, San Francisco, CA, USA
| | - Bonnie N Joe
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark Rosen
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Pulin Sheth
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Karen Y Oh
- Oregon Health & Science University, Portland, OR, USA
| | - Neda Jafarian
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Wei T Yang
- University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Basak Dogan
- University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Don Berry
- Berry Consultants, LLC, Austin, TX, USA
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15
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Li W, Onishi N, Newitt DC, Harnish R, Jones EF, Wilmes LJ, Gibbs J, Price E, Joe BN, Chien AJ, Berry DA, Boughey JC, Albain KS, Clark AS, Edmiston KK, Elias AD, Ellis ED, Euhus DM, Han HS, Isaacs C, Khan QJ, Lang JE, Lu J, Meisel JL, Mitri Z, Nanda R, Northfelt DW, Sanft T, Stringer-Reasor E, Viscusi RK, Wallace AM, Yee D, Yung R, Melisko ME, Perlmutter J, Rugo HS, Schwab R, Symmans WF, van't Veer LJ, Yau C, Asare SM, DeMichele A, Goudreau S, Abe H, Sheth D, Wolverton D, Fountain K, Ha R, Wynn R, Crane EP, Dillis C, Kuritza T, Morley K, Nelson M, Church A, Niell B, Drukteinis J, Oh KY, Jafarian N, Brandt K, Choudhery S, Bang DH, Mullins C, Woodard S, Zamora KW, Ojeda-Fornier H, Eghedari M, Sheth P, Hovanessian-Larsen L, Rosen M, McDonald ES, Spektor M, Giurescu M, Newell MS, Cohen MA, Berman E, Lehman C, Smith W, Fitzpatrick K, Borders MH, Yang W, Dogan B, Esserman LJ, Hylton NM. Abstract P6-02-01: The effect of background parenchymal enhancement on the predictive performance of functional tumor volume measured in MRI. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p6-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Strong background parenchymal enhancement (BPE) may cause overestimation in tumor volume measured from dynamic contrast-enhanced (DCE) MRI, which may adversely affect the ability of MR tumor volume to predict treatment outcome for patients undergoing neoadjuvant chemotherapy (NAC). Specifically, an overestimation of tumor volume can result in misclassification of patients with complete pathologic response (pCR) as non-responders, leading to less confidence in MRI prediction. As well, overestimation of extent of disease might lead to more aggressive surgical therapy than necessary. This study investigated whether high BPE in the contralateral breast influences the predictive performance of MRI-measured functional tumor volume (FTV) for patients with locally advanced breast cancer undergoing NAC.
Methods: patients (n=990) enrolled in the I-SPY 2 TRIAL who were randomized to the graduated experimental drug arms or controls from 2010 to 2016 were analyzed. Each patient had 4 MRI exams: pre-NAC (T0), after 3 weeks of NAC (T1), between NAC regimens (T2), and post-NAC (T3). FTV was calculated at each MRI exam by summing voxels meeting enhancement thresholds. Background parenchymal enhancement (BPE) in the contralateral breast was calculated automatically as mean percentage enhancement on the early (nominal 150sec post-contrast) image in the fibroglandular tissue segmented from 5 continuous axial slices centered in the inferior-to-superior stack. For each treatment time point, patients having both FTV and BPE measurements were included in the analysis. The area under the ROC curve (AUC) was estimated as the association between FTV and pCR at T1, T2, and T3. The analysis was conducted in the full patient cohort and in sub-cohorts defined by hormone receptor (HR) and HER2 status. In each patient cohort, a cut-off BPE value was selected to classify patients with high vs. low BPE by testing AUCs estimated with low-BPE patients reached maximum when the cut-off value varied from median to maximum in steps of 10%.
Results: Out of 990 patients, 878 had pCR outcome data (pCR or non-pCR, pCR rate = 35%). Table 1 shows the number of patients, pCR rate, and AUC of FTV for predicting pCR using all patients available vs. a subset patients with low BPE (< BPE cut-off). In the full cohort, AUC increased slightly across all time points after patients with high BPE were removed. In the HR+/HER2- subtype, AUC increased at T1 after removal of cases with high BPE (0.65 vs. 0.71). For HR-/HER2+, AUC increased substantially after removal of high BPE cases (0.65 to 0.86 at T1, 0.71 to 0.87 at T2, and 0.71 to 0.89 at T3), with greater improvement at the early time point (T1) compared to later time points (T2 and T3). Only a slight improvement in the AUC was observed in the HR+/HER2+ and HR-/HER2- subtypes across all time points.
Conclusions: High background parenchymal enhancement adversely affected the predictive performance of functional tumor volume measured by DCE-MRI, at early treatment time point for HR+/HER2- and across all time points for HR-/HER2+ cancer subtype. The adverse effect might be offset using subtype-optimized enhancement threshold in calculating functional tumor volume.
Table 1 Effect of BPE on the prediction of pCR using FTV at various treatment time pointsT1T2T3npCR rateAUCBPE cut-offnpCR rateAUCBPE cut-offnpCR rateAUCBPE cut-offFullAll64734%0.662762334%0.701761134%0.6925Subset45334%0.6831133%0.7230534%0.72HR+/HER2-All26218%0.651924918%0.718225518%0.7519Subset13118%0.7124818%0.7120419%0.76HR+/HER2+All10636%0.642110538%0.62269634%0.7120Subset5332%0.668438%0.665740%0.73HR-/HER2+All5175%0.65204774%0.71204973%0.7116Subset3073%0.862871%0.872475%0.89HR-/HER2-All22842%0.682822243%0.751821143%0.6916Subset15940%0.7111137%0.7810540%0.75
Citation Format: Wen Li, Natsuko Onishi, David C Newitt, Roy Harnish, Ella F Jones, Lisa J Wilmes, Jessica Gibbs, Elissa Price, Bonnie N Joe, A. Jo Chien, Donald A Berry, Judy C Boughey, Kathy S Albain, Amy S Clark, Kirsten K Edmiston, Anthony D Elias, Erin D Ellis, David M Euhus, Heather S Han, Claudine Isaacs, Qamar J Khan, Julie E Lang, Janice Lu, Jane L Meisel, Zaha Mitri, Rita Nanda, Donald W Northfelt, Tara Sanft, Erica Stringer-Reasor, Rebecca K Viscusi, Anne M Wallace, Douglas Yee, Rachel Yung, Michelle E Melisko, Jane Perlmutter, Hope S Rugo, Richard Schwab, W. Fraser Symmans, Laura J van't Veer, Christina Yau, Smita M Asare, Angela DeMichele, Sally Goudreau, Hiroyuki Abe, Deepa Sheth, Dulcy Wolverton, Kelly Fountain, Richard Ha, Ralph Wynn, Erin P Crane, Charlotte Dillis, Theresa Kuritza, Kevin Morley, Michael Nelson, An Church, Bethany Niell, Jennifer Drukteinis, Karen Y Oh, Neda Jafarian, Kathy Brandt, Sadia Choudhery, Dae Hee Bang, Christiane Mullins, Stefanie Woodard, Kathryn W Zamora, Haydee Ojeda-Fornier, Mohammad Eghedari, Pulin Sheth, Linda Hovanessian-Larsen, Mark Rosen, Elizabeth S McDonald, Michael Spektor, Marina Giurescu, Mary S Newell, Michael A Cohen, Elise Berman, Constance Lehman, William Smith, Kim Fitzpatrick, Marisa H Borders, Wei Yang, Basak Dogan, Laura J Esserman, Nola M Hylton. The effect of background parenchymal enhancement on the predictive performance of functional tumor volume measured in MRI [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-02-01.
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Affiliation(s)
- Wen Li
- 1University of California, San Francisco, San Francisco, CA
| | - Natsuko Onishi
- 1University of California, San Francisco, San Francisco, CA
| | - David C Newitt
- 1University of California, San Francisco, San Francisco, CA
| | - Roy Harnish
- 1University of California, San Francisco, San Francisco, CA
| | - Ella F Jones
- 1University of California, San Francisco, San Francisco, CA
| | - Lisa J Wilmes
- 1University of California, San Francisco, San Francisco, CA
| | - Jessica Gibbs
- 1University of California, San Francisco, San Francisco, CA
| | - Elissa Price
- 1University of California, San Francisco, San Francisco, CA
| | - Bonnie N Joe
- 1University of California, San Francisco, San Francisco, CA
| | - A. Jo Chien
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | - Amy S Clark
- 5University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | - Julie E Lang
- 13University of Southern California, Los Angeles, CA
| | - Janice Lu
- 13University of Southern California, Los Angeles, CA
| | | | - Zaha Mitri
- 15Oregon Health & Science University, Portland, OR
| | - Rita Nanda
- 16The University of Chicago Medical Center, Chicago, IL
| | | | | | | | | | | | | | - Rachel Yung
- 23CTEP, National Cancer Institute, Rockville, MD
| | | | | | - Hope S Rugo
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | - Christina Yau
- 1University of California, San Francisco, San Francisco, CA
| | - Smita M Asare
- 26Quantum Leap Healthcare Collaborative, San Francisco, CA
| | | | - Sally Goudreau
- 27University of Texas Southwestern Medical Center, Dallas, TX
| | - Hiroyuki Abe
- 16The University of Chicago Medical Center, Chicago, IL
| | - Deepa Sheth
- 16The University of Chicago Medical Center, Chicago, IL
| | | | | | - Richard Ha
- 28Columbia University, New York City, NY
| | - Ralph Wynn
- 28Columbia University, New York City, NY
| | | | | | | | | | | | - An Church
- 22University of Minnesota, Minneapolis, MN
| | | | | | - Karen Y Oh
- 15Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | | | | | - Pulin Sheth
- 13University of Southern California, Los Angeles, CA
| | | | - Mark Rosen
- 5University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | | - Wei Yang
- 25University of Texas, M.D. Anderson Cancer Center, Houston, TX
| | - Basak Dogan
- 25University of Texas, M.D. Anderson Cancer Center, Houston, TX
| | | | - Nola M Hylton
- 1University of California, San Francisco, San Francisco, CA
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16
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Li W, Onishi N, Newitt DC, Gibbs J, Wilmes LJ, Jones EF, Joe BN, Sit LS, Yau C, Chien AJ, Price E, Albain KS, Kuritza T, Morley K, Boughey JC, Brandt K, Choudhery S, Clark AS, Rosen M, McDonald ES, Elias AD, Wolverton D, Fountain K, Euhus DM, Han HS, Niell B, Drukteinis J, Lang JE, Lu J, Meisel JL, Mitri Z, Nanda R, Northfelt DW, Sanft T, Stringer-Reasor E, Viscusi RK, Wallace AM, Yee D, Yung R, Asare SM, Melisko ME, Perlmutter J, Rugo HS, Schwab R, Symmans WF, van't Veer LJ, Berry DA, DeMichele A, Abe H, Sheth D, Edmiston KK, Ellis ED, Ha R, Wynn R, Crane EP, Dillis C, Nelson M, Church A, Isaacs C, Khan QJ, Oh KY, Jafarian N, Bang DH, Mullins C, Woodard S, Zamora KW, Ojeda-Fornier H, Sheth P, Hovanessian-Larsen L, Eghtedari M, Spektor M, Giurescu M, Newell MS, Cohen MA, Berman E, Lehman C, Smith W, Fitzpatrick K, Borders MH, Yang W, Dogan B, Goudreau S, Brown T, Esserman LJ, Hylton NM. Abstract PD9-04: Breast cancer subtype specific association of pCR with MRI assessed tumor volume progression during NAC in the I-SPY 2 trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd9-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In an adaptive randomized trial, when new treatment combinations are being tested, it is important to be able to identify patients who are progressing on treatment so that they can be changed to a different therapeutic regimen. We know that even within the molecularly high risk patients in I-SPY 2, there is considerable variation in biology. In this study, we will present results of using MRI-calculated functional tumor volume (FTV) to identify tumor progression for each breast cancer subtype.
Methods: Patients (n=990) enrolled in the I-SPY 2 TRIAL who were randomized to the graduated experimental drug arms or controls from 2010 to 2016 were analyzed. Four MRI exams were performed for each patient: pre-NAC (T0), after 3 weeks of NAC (T1), between regimens (T2), and post-NAC (T3). Functional tumor volume (FTV) was calculated at each exam by summing voxels meeting enhancement thresholds. Tumor progression at T1, T2 or T3 was identified by a positive FTV change relative to T0. Visual inspection was used to exclude false progression due to strong background parenchymal enhancement post-contrast, prominent vessels, motion, or insufficient image quality. pCR was defined as no invasive disease in the breast and lymph nodes. Negative predictive value for pCR was defined as:NPV=number of true non-pCRs / number of patients with MRI assessed tumor progressions, where “true non-pCRs” referred to patients who were non-pCRs at surgery and were assessed as progressors by MRI. The analysis was performed in the full cohort and in sub-cohorts defined by HR and HER2 statuses.
Results: Out of 990 patients, 878 had pCR outcome data (pCR or non-pCR, pCR rate = 35%). Total and non-pCR numbers for each subtype, number of patients with tumor progression assessed by MRI at T1, T2, and T3, and NPVs, are shown in Table 1. In the full cohort, the NPV increased consistently over treatment, from T1 (NPV=83%) to T2 (93%), and to T3 (100%). The HER2+ cancer subtypes showed fewer MRI-assessed tumor progressions than HER2- subtypes: e.g. 10/209 (5%) vs. 108/669 (16%) at T1. NPV was 100% for HER2+ subtypes at T1 and T2 except for a single misclassification of a HR- tumor at T1. Only 6 tumor progressors, all HER2- were identified at T3, and all were confirmed at surgery as non-pCRs (NPV=100%). For HR+/HER2-, the NPV increased slightly from 89% at T1 to 91% at T2, while triple negative subtype had a more substantial increase, from 78% to 92%.
Conclusions: Our study showed strong association between tumor progressors assessed by MRI with true non-pCRs after NAC. For HER2+ tumors, although MRI progressors are rare, they strongly indicate non-pCR at all treatment time points, while HER2- subtypes show more accurate results later in treatment. We are evaluating MRI change at 6 weeks to determine if that time point is sufficient to predict progressors.
Table 1 MRI assessed tumor progression at different treatment time pointN/non-pCRs/%non-pCRMRI assessed tumor progressionT1 (after 3 weeks)T2 (inter-regimen)T3 (post-NAC)NNPV (%)NNPV (%)NNPV (%)Full cohort878/572/65%11883.14192.76100%HR+/HER2-344/280/81%4588.91190.93100%HR+/HER2+134/85/63%610021000N/AHR-/HER2+75/23/31%47521000N/Atriple negative325/184/57%6377.82692.33100%
Citation Format: Wen Li, Natsuko Onishi, David C Newitt, Jessica Gibbs, Lisa J Wilmes, Ella F Jones, Bonnie N Joe, Laura S Sit, Christina Yau, A. Jo Chien, Elissa Price, Kathy S Albain, Theresa Kuritza, Kevin Morley, Judy C Boughey, Kathy Brandt, Sadia Choudhery, Amy S Clark, Mark Rosen, Elizabeth S McDonald, Anthony D Elias, Dulcy Wolverton, Kelly Fountain, David M Euhus, Heather S Han, Bethany Niell, Jennifer Drukteinis, Julie E Lang, Janice Lu, Jane L Meisel, Zaha Mitri, Rita Nanda, Donald W Northfelt, Tara Sanft, Erica Stringer-Reasor, Rebecca K Viscusi, Anne M Wallace, Douglas Yee, Rachel Yung, Smita M Asare, Michelle E Melisko, Jane Perlmutter, Hope S Rugo, Richard Schwab, W. Fraser Symmans, Laura J van't Veer, Donald A Berry, Angela DeMichele, Hiroyuki Abe, Deepa Sheth, Kirsten K Edmiston, Erin D Ellis, Richard Ha, Ralph Wynn, Erin P Crane, Charlotte Dillis, Michael Nelson, An Church, Claudine Isaacs, Qamar J Khan, Karen Y Oh, Neda Jafarian, Dae Hee Bang, Christiane Mullins, Stefanie Woodard, Kathryn W Zamora, Haydee Ojeda-Fornier, Pulin Sheth, Linda Hovanessian-Larsen, Mohammad Eghtedari, Michael Spektor, Marina Giurescu, Mary S Newell, Michael A Cohen, Elise Berman, Constance Lehman, William Smith, Kim Fitzpatrick, Marisa H Borders, Wei Yang, Basak Dogan, Sally Goudreau, Thelma Brown, Laura J Esserman, Nola M Hylton. Breast cancer subtype specific association of pCR with MRI assessed tumor volume progression during NAC in the I-SPY 2 trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD9-04.
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Affiliation(s)
- Wen Li
- 1University of California, San Francisco, San Francisco, CA
| | - Natsuko Onishi
- 1University of California, San Francisco, San Francisco, CA
| | - David C Newitt
- 1University of California, San Francisco, San Francisco, CA
| | - Jessica Gibbs
- 1University of California, San Francisco, San Francisco, CA
| | - Lisa J Wilmes
- 1University of California, San Francisco, San Francisco, CA
| | - Ella F Jones
- 1University of California, San Francisco, San Francisco, CA
| | - Bonnie N Joe
- 1University of California, San Francisco, San Francisco, CA
| | - Laura S Sit
- 1University of California, San Francisco, San Francisco, CA
| | - Christina Yau
- 1University of California, San Francisco, San Francisco, CA
| | - A. Jo Chien
- 1University of California, San Francisco, San Francisco, CA
| | - Elissa Price
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | | | - Amy S Clark
- 4University of Pennsylvania, Philadelphia, PA
| | - Mark Rosen
- 4University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | - Julie E Lang
- 8University of Southern California, Los Angeles, CA
| | - Janice Lu
- 8University of Southern California, Los Angeles, CA
| | | | - Zaha Mitri
- 10Oregon Health & Science University, Portland, OR
| | - Rita Nanda
- 11The University of Chicago Medical Center, Chicago, IL
| | | | | | | | | | | | | | - Rachel Yung
- 18CTEP, National Cancer Institute, Rockville, MD
| | - Smita M Asare
- 19Quantum Leap Healthcare Collaborative, San Francisco, CA
| | | | | | - Hope S Rugo
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | - Hiroyuki Abe
- 11The University of Chicago Medical Center, Chicago, IL
| | - Deepa Sheth
- 11The University of Chicago Medical Center, Chicago, IL
| | | | | | - Richard Ha
- 25Columbia University, New York City, NY
| | - Ralph Wynn
- 25Columbia University, New York City, NY
| | | | | | | | - An Church
- 17University of Minnesota, Minneapolis, MN
| | | | | | - Karen Y Oh
- 10Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | - Pulin Sheth
- 8University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | | | | | - Wei Yang
- 21University of Texas, M.D. Anderson Cancer Center, Houston, TX
| | - Basak Dogan
- 21University of Texas, M.D. Anderson Cancer Center, Houston, TX
| | - Sally Goudreau
- 30University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Nola M Hylton
- 1University of California, San Francisco, San Francisco, CA
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Dogan B, Karaer A, Tuncay G, Tecellioglu N, Mumcu A. High-resolution 1H-NMR spectroscopy indicates variations in metabolomics profile of follicular fluid from women with advanced maternal age. J Assist Reprod Genet 2020; 37:321-330. [PMID: 31942667 DOI: 10.1007/s10815-020-01693-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/10/2020] [Indexed: 12/31/2022] Open
Abstract
AIM To reveal whether there are differences in follicular fluid metabolomics profile of women with advanced maternal age (AMA). METHOD The group with advanced maternal age includes 23 patients above the age of 40, and the control group includes 31 patients aged between 25 and 35 years and AMH values above 1.1 ng/mL with no low ovarian response history. A single follicular fluid sample from a MII oocyte obtained during the oocyte pick-up procedure was analyzed with high-resolution 1H-NMR (nuclear magnetic resonance) spectroscopy. The results were evaluated using advanced bioinformatics analysis methods. RESULTS Statistical analysis of the NMR spectroscopy data from two groups showed that α-glucose and β-glucose levels of follicular fluid were decreased in the patients with AMA, while in contrast, lactate and trimethylamine N-oxide (TMAO) levels were increased in these patients compared with the controls. In addition to these, there was an increase in alanine levels and a decrease in acetoacetate levels in patients with AMA. However, these changes were not statistically significant. CONCLUSION Obtained results suggest that the follicular cell metabolism of patients with AMA is different from controls. These environmental changes could be associated with the low success rates of IVF treatment seen in these patients.
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Affiliation(s)
- B Dogan
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Department of Biomedical Engineering, School of Engineering, Inonu University, Malatya, Turkey
| | - A Karaer
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey. .,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University, School of Medicine, Malatya, Turkey.
| | - G Tuncay
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University, School of Medicine, Malatya, Turkey
| | - N Tecellioglu
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University, School of Medicine, Malatya, Turkey
| | - A Mumcu
- Reproductive Sciences & Advanced Bioinformatics Application & Research Center, Inonu University, Malatya, Turkey.,Laboratory of NMR, Scientific and Technological Research Center, Inonu University, Malatya, Turkey
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18
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Abstract
ABSTRACTObjectives: The aim of this study was to compare the differences in self-reported oral health attitudes and behaviour between preclinical and clinical dental students in Turkey using Hiroshima University Dental Behavioural Inventory (HU-DBI). Methods: A Turkish version HU-DBI questionnaire with additional 7 questions, totally 27 items, was distributed among 1022 dental students. Results: The response rate was 75% (486 preclinical and 278 clinical students). Significantly higher (P=0.000) percentage of the preclinical students, compared to clinical students, worry about colour of their teeth, are bothered by the colour of their gums, put off going to the dentist until they have a toothache; think that their teeth are getting worse despite their daily brushing, it is impossible to prevent gum disease with tooth brushing alone, and they cannot help having false teeth when they are old. Moreover, the preclinical students more frequently agree on that their gums tend to bleed when they brush their teeth, they use a toothbrush which has hard bristles, and they don’t feel they’ve brushed well unless with strong strokes (P=0.000). However, a higher proportion of clinical students compared to preclinical students brush each of their teeth carefully, think that they can clean their teeth without using toothpaste, have had their dentist tell them that they brush very well (P=0.000). The HU-DBI score of clinical students (7.47±1.86) was significantly (P=0.000) higher than preclinical students (6.00±1.86). Conclusions: Dental students should have a comprehensive program, including their self-care regimes, starting from their first year of education. (Eur J Dent 2011;5:253-259)
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Affiliation(s)
- Sinem Yildiz
- Marmara University, Faculty of Dentistry, Department of Periodontology, Istanbul, Turkey
| | - Basak Dogan
- Marmara University, Faculty of Dentistry, Department of Periodontology, Istanbul, Turkey
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19
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Mumcu A, Karaer A, Dogan B, Tuncay G. Metabolomics analysis of seminal plasma in patients with idiopathic Oligoasthenoteratozoospermia using high-resolution NMR spectroscopy. Andrology 2019; 8:450-456. [PMID: 31520509 DOI: 10.1111/andr.12707] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/08/2019] [Accepted: 09/10/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Male infertility is a global health issue caused by a combination of different factors. Specialists generally rely on semen analysis to diagnose male infertility. However, it is known that diagnostic semen analysis fails to identify about 50% of male infertility disorders. Recently, metabolomics has been proven to be a powerful technique for the diagnosis of different diseases. OBJECTIVE To determine whether metabolites could be used as potential biomarkers for the diagnosis of male factor infertility through comparing seminal plasma samples from infertile men with oligoasthenoteratozospermia (OAT) and samples from normozoospermic controls. MATERIALS AND METHODS This study utilized high-resolution 1 H NMR spectroscopy to reveal whether the metabolomic changes of seminal plasma obtained from 31 patients with oligoasthenoteratozospermia (OAT) are different from the ones obtained from 28 normozoospermic controls. RESULTS Multivariate statistical analysis of NMR data concluded that the metabolomic profile of samples from patients with OAT exhibits statistically significant differences when compared to the controls. The differences were based on the metabolites lactate, citrate, lysine, arginine, valine, glutamine, creatinine, α-ketoglutaric acid, spermine, putrescine, and tyrosine. Except the tyrosine, levels of the above metabolites were significantly decreased in patients with OAT compared to the controls. The levels of citrate, choline, spermine, putrescine, α-ketoglutaric acid, valine, and tyrosine were significantly different (p < 5 × 10-4 ) between two groups. On the other hand, levels of lactate, creatinine, lysine, arginine, and glutamine were also statistically significant (0.001 < p < 0.05). However, considering the p-values, the physiological relevance of these metabolites may be lower when compared to the others. A PLS-DA model built on the NMR data achieved 89.29% sensitivity and 93.55% specificity results in a leave-one-out cross-validation process. DISCUSSION AND CONCLUSION 1 H NMR spectroscopy-based metabolomic analysis could be used as a diagnostic tool for the diagnosis of oligoasthenoteratozospermia.
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Affiliation(s)
- A Mumcu
- Laboratory of NMR, Scientific and Technological Research Center, Inonu University, Malatya, Turkey
| | - A Karaer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, Inonu University, Malatya, Turkey
| | - B Dogan
- Department of Biomedical Engineering, School of Engineering, Inonu University, Malatya, Turkey
| | - G Tuncay
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, Inonu University, Malatya, Turkey
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20
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Baydoun S, Gonzalez P, Whitman GJ, Dryden M, Xi Y, Dogan B. Is Ductography Still Warranted in the 21st century? Breast J 2019; 25:654-662. [PMID: 31087408 DOI: 10.1111/tbj.13302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple-modality evaluation. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients who had presented with pathologic nipple discharge and had undergone mammography and/or ultrasound and ductography between January 1, 2005, and October 31, 2010. We tested the diagnostic sensitivity, specificity and accuracy of combined triple-modality evaluation as well as of MRI performed in addition to these imaging techniques. We used the gold standard of image-guided biopsies, surgical excision, or long-term clinical and imaging follow-up. RESULTS Among 94 study patients, benign papillomas were identified in 42 (44.7%), abscess in one (1%), duct ectasia in four (4.3%), and malignancy (invasive ductal carcinoma or ductal carcinoma in situ) or high-risk lesion (atypical ductal hyperplasia) in 10 (10.6%). Forty-six patients (49%) underwent surgical excision; 89.1% of which had presurgical planning with ductography. In 35 (37.2%) with negative imaging, resolution of nipple discharge was confirmed on median clinical and imaging follow-up of 36 months. Two patients with negative imaging were lost to follow-up. Sensitivity, specificity, PPV, and NPV for accurately demonstrating the etiology of pathologic nipple discharge were 13%, 97%, 89%, and 37% respectively for mammography; 73%, 97%, 98%, and 64% respectively for ultrasound; 76%, 72%, 84%, and 61% respectively for ductography; 86%, 70%, 85%, and 72% respectively for combined ultrasound and ductography; and 75%, 100%, 100% and 67% respectively for DCE-MRI. CONCLUSION The combination of mammography, ultrasound and ductography is highly accurate for identifying the etiology of pathologic nipple discharge. DCE-MRI can be used as an alternate to ductography if necessary.
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Affiliation(s)
- Serine Baydoun
- Department of Diagnostic Radiology, American University of Beirut, Beirut, Lebanon
| | - Pedro Gonzalez
- Breast Imaging Department, CT Radiology Complex, Bayamon, Puerto Rico
| | - Gary J Whitman
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Dryden
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yin Xi
- Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Basak Dogan
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Morova B, Bavili N, Yaman O, Yigit B, Zeybel M, Aydın M, Dogan B, Kasztelanic R, Pysz D, Buczynski R, Kiraz A. Fabrication and characterization of large numerical aperture, high-resolution optical fiber bundles based on high-contrast pairs of soft glasses for fluorescence imaging. Opt Express 2019; 27:9502-9515. [PMID: 31045101 DOI: 10.1364/oe.27.009502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Fabrication and characterization of flexible optical fiber bundles (FBs) with in-house synthesized high-index and low-index thermally matched glasses are presented. The FBs composed of around 15000 single-core fibers with pixel sizes between 1.1 and 10 μm are fabricated using the stack-and-draw technique from sets of thermally matched zirconium-silicate ZR3, borosilicate SK222, sodium-silicate K209, and F2 glasses. With high refractive index contrast pair of glasses ZR3/SK222 and K209/F2, FBs with numerical apertures (NAs) of 0.53 and 0.59 are obtained, respectively. Among the studied glass materials, ZR3, SK222, and K209 are in-house synthesized, while F2 is commercially acquired. Seven different FBs with varying pixel sizes and bundle diameters are characterized. Brightfield imaging of a micro-ruler and a Convallaria majalis sample and fluorescence imaging of a dye-stained paper tissue and a cirrhotic mice liver tissue are demonstrated using these FBs, demonstrating their good potential for microendoscopic imaging. Brightfield and fluorescence imaging performance of the studied FBs are compared. For both sets of glass compositions, good imaging performance is observed for FBs, with core diameter and core-to-core distance values larger than 1.6 μm and 2.3 μm, respectively. FBs fabricated with K209/F2 glass pairs revealed better performance in fluorescence imaging due to their higher NA of 0.59.
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22
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van der Noordaa ME, Esserman L, Yau C, Mukhtar R, Price E, Hylton N, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, van 't Veer L, Hirst G, Lancaster R, Wallace A, Alvaredo M, Symmans F, Asare S, Boughey JC. Abstract PD4-04: Role of breast MRI in predicting pathologically negative nodes after neoadjuvant chemotherapy in cN0 patients in the I-SPY2 trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd4-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
In clinically node-negative (cN0) breast cancer patients with triple negative (TN) and HER2+ disease and breast pathological complete response (breast pCR), low rates of nodal positivity after neoadjuvant chemotherapy (NAC) have been demonstrated. In these patients, the omission of surgical axillary staging has been proposed. However, this information is not routinely known preoperatively. We aimed to validate the correlation between pathologic breast response and pathologic nodal status, and evaluate the relationship between response of the breast tumor on MRI and pathologic nodal status after NAC in cN0 patients in the I-SPY2 trial.
Methods
We identified all patients with cT1-4 cN0 breast cancer prior to NAC from graduated arms of the I-SPY2 trial, a prospective neoadjuvant chemotherapy trial. Absence of residual disease post-NAC was defined as longest diameter (LD) of 0 mm on MRI. Breast pCR was defined as the absence of invasive tumor in the breast at surgery. Associations between ypN0 and patient, MRI, and tumor characteristics were assessed using chi-square tests and univariate regression.
Results
Of 365 cT1-4 cN0 patients included, 128 had HR+/HER2- tumors (35%), 60 HR+/HER2+ tumors (16%), 34 HR-/HER2+ tumors (9%) and 143 TN tumors (39%). Overall, 283 patients (78%) were ypN0 after NAC and 152 patients (42%) had a breast pCR. ypN0 rate was higher in patients with a breast pCR than those with residual disease (93% vs 66%, p<0.001). Patients with HR-/HER2+ and TN tumors were more likely to be ypN0 (97% and 87% respectively) than patients with HR+/HER2- and HR+/HER2+ disease (66% and 71% respectively, p<0.001). Other characteristics associated with ypN0 were tumor grade (grade I 57%, grade II 66%, grade III 84%; p=0.002), MammaPrint Classification (High Risk 1 68% and High Risk 2 87%; p<0.001) and absence of residual tumor in the breast on MRI (87% vs 72% in patients with evidence of tumor on MRI post-NAC/pre-surgery; p=0.003).
In patients with HR-/HER2+, HR+/HER2+, HR-/HER2+ or TN disease and a breast pCR, ypN0 rate was respectively 82%, 96%, 96% and 97% (table 1). In patients with HR+/HER2-, HR+/HER2+, HR-/HER2+ or TN disease and with no evidence of residual disease in the breast on MRI, rate of ypN0 was 71%, 80%, 94% and 96% respectively.
Conclusion
In cT1-4 cN0 breast cancer patients with HR+/HER2+, HR-/HER2+ and TN tumors and a breast pCR, ypN0 rates after NAC are extremely high. In patients with HR-/HER2+ and TN tumors with no residual breast disease on MRI after NAC and pre-surgery, ypN0 rates are high enough to consider omission of axillary surgery. In patients with HR+ tumors, MRI is unsufficiently predictive for pathological response and can therefore not be used to select ypN0 patients. Research on the prediction of ypN0 in cN+ I-SPY2 patients is ongoing.
Nodal status in patients with pCR and absence of residual disease on MRI Number of positive nodesBreast Cancer Subtype0123AllBreast pCR HR+/HER2-27(82)2(6)4(12)033(100)HR+/HER2+24(96)01(4)025(100)HR-/HER2+24(96)1(4)0025(100)TN67(97)2(3)0069(100)Absence of residual disease on MRI HR+/HER2-24(71)7(21)3(9)034(100)HR+/HER2+16(80)3(15)01(5)20(100)HR-/HER2+15(94)1(6)0016(100)TN54(96)2(4)0056(100)
Citation Format: van der Noordaa ME, Esserman L, Yau C, Mukhtar R, Price E, Hylton N, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, van 't Veer L, Hirst G, Lancaster R, Wallace A, Alvaredo M, Symmans F, Asare S, Boughey JC, I-SPY2 Consortium. Role of breast MRI in predicting pathologically negative nodes after neoadjuvant chemotherapy in cN0 patients in the I-SPY2 trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD4-04.
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Affiliation(s)
- ME van der Noordaa
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - L Esserman
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - C Yau
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - R Mukhtar
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - E Price
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - N Hylton
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - H Abe
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - D Wolverton
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - EP Crane
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - KA Ward
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - M Nelson
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - BL Niell
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - K Oh
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - KR Brandt
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - DH Bang
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - H Ojeda-Fournier
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - M Eghtedari
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - PA Sheth
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - WK Bernreuter
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - H Umphrey
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - MA Rosen
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - B Dogan
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - W Yang
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - B Joe
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - L van 't Veer
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - G Hirst
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - R Lancaster
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - A Wallace
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - M Alvaredo
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - F Symmans
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - S Asare
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
| | - JC Boughey
- University of California San Francisco, San Francisco; Antoni van Leeuwenhoek Hospital / Netherlands Cancer Institute, Amsterdam, Netherlands; University of Chicago, Chicago; University of Colorado, Aurora; Georgetown University, Washington, DC; Loyola University Medical Center, Maywood; University of Minnesota, Minneapolis; Moffitt Cancer Center, Tampa; Oregon Health & Science University, Portland; Mayo Clinic, Rochester; Swedish Hospital, Seattle; University of California San Diego, La Jolla; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Pennsylvania, Philadelphia; UT Southwestern, Houston; MD Anderson, Houston
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Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen YY, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Abstract P2-07-03: Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients achieving a pathologic complete response (pCR) following neoadjuvant therapy have significantly improved event-free survival relative to those who do not; and pCR is an FDA-accepted endpoint to support accelerated approval of novel agents/combinations in the neoadjuvant treatment of high risk early stage breast cancer. Previous studies have shown that recurrence risk increased with increasing burden of residual disease (as assessed by the RCB index). As well, these studies suggest that patients with minimum residual disease (RCB-I class) also have favorable outcomes (comparable to those achieving a pCR) within high risk tumor subtypes. In this study, we assess whether integrating RCB with MRI functional tumor volume (FTV), which in itself is prognostic, can improve prediction of distant recurrence free survival (DRFS); and identify a subset of patients with minimal residual disease with comparable DRFS as those who achieved a pCR. Imaging tools can then be used to identify the subset that will do well early and guide the timing of surgical therapy.
Method: We performed a pooled analysis of 596 patients from the I-SPY2 TRIAL with RCB, pre-surgical MRI FTV data and known follow-up (median 2.5 years). We first assessed whether FTV predicts residual disease (pCR or pCR/RCB-I) using ROC analysis. We applied a power transformation to normalize the pre-surgical FTV distribution; and assessed its association with DRFS using a bi-variate Cox proportional hazard model adjusting for HR/HER2 subtype. We also fitted a bivariate Cox model of RCB index adjusting for subtype; and assessed whether adding pre-surgical FTV to this model further improves association with DRFS using a likelihood ratio (LR) test. For the Cox modeling, penalized splines approximation of the transformed FTV and RCB index with 2 degrees of freedom was used to allow for non-linear effects of FTV and RCB on DRFS.
Result: Pre-surgical MRI FTV is significantly associated with DRFS (Wald p<0.00001), and more effective at predicting pCR/RCB-I than predicting pCR alone (AUC: 0.72 vs. 0.65). Larger pre-surgical FTV remains associated with worse DRFS adjusting for subtype (Wald p <0.00001). The RCB index is also significantly associated with DRFS adjusting for subtype (Wald p<0.00001). Adding FTV to a model containing RCB and subtype further improves association with DRFS (LR p=0.0007). RCB-I patients have excellent DRFS (94% at 3 years compared to 95% in the pCR group). Efforts are underway to identify an optimal threshold for dichotomizing pre-surgical FTV and FTV change measures for use in combination with pCR/RCB-I class to generate integrated RCB (iRCB) groups as a composite predictor of DRFS.
Conclusion: Pre-surgical MRI FTV is effective at predicting minimal residual disease (RCB0/I) in the I-SPY 2 TRIAL. Despite the association between FTV and RCB, FTV appears to provide independent added prognostic value (to RCB and subtype), suggesting that integrating MRI volume measures and RCB into a composite predictor may improve DRFS prediction.
Citation Format: Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen Y-Y, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, I-SPY 2 TRIAL Consortium, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-03.
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Affiliation(s)
- NM Hylton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WF Symmans
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Yau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Li
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Hatzis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Isaacs
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KS Albain
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - Y-Y Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Krings
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Wei
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Harada
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Datnow
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Fadare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Klein
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Pambuccian
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Adamson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - P Mhawech-Fauceglia
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Magliocco
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Feldman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Rendi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Sattar
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Zeck
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - I Ocal
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Tawfik
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Grasso LeBeau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sahoo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Vinh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Adams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AJ Chien
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Ferero-Torres
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - E Stringer-Reasor
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wallace
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JC Boughey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ED Ellis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AD Elias
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JE Lang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Lu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Han
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AS Clark
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Korde
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Nanda
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DW Northfelt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - QJ Khan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - RK Viscusi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DM Euhus
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KK Edmiston
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SY Chui
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Kemmer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WC Wood
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JW Park
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MC Liu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Olopade
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Tripathy
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SL Moulder
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Rugo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Schwab
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Lo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Helsten
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Beckwith
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PK Haugen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ van't Veer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Perlmutter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ME Melisko
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wilson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Peterson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AL Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MB Buxton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Paoloni
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JL Clennell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - GL Hirst
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Singhrao
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Steeg
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JB Matthews
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Sanil
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Abe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Wolverton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - EP Crane
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KA Ward
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Nelson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - BL Niell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Oh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KR Brandt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DH Bang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Ojeda-Fournier
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Eghtedari
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PA Sheth
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WK Bernreuter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Umphrey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MA Rosen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Dogan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Joe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Yee
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Pusztai
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A DeMichele
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DA Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ Esserman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
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Li W, Newitt D, Yun BL, Kornak J, Joe B, Yau C, Abe H, Wolverton D, Crane E, Ward K, Nelson M, Niell B, Drukteinis J, Oh K, Brandt K, Bang DH, Ojeda H, Eghtedari M, Sheth P, Bernreuter W, Umphrey H, Rosen M, Dogan B, Yang W, Esserman L, Hylton N. Abstract PD4-03: MRI detection of residual disease following neoadjuvant chemotherapy (NAC) in the I-SPY 2 TRIAL. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd4-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Detecting residual disease accurately using MRI after NAC to identify both responders and non-responders is essential for de-escalating therapy or redirecting patients to more effective treatment. The purpose of this study is to determine if the combination of longest diameter (LD) and functional tumor volume (FTV) from dynamic contrast enhanced (DCE-) MRI is superior to FTV alone or LD alone for assessing treatment response after neoadjuvant therapy in breast cancer patients.
Methods: Data from patients in the graduated drug arms of the I-SPY 2 trial were included in the analysis. Both LD and FTV were assessed using DCE-MRI after neoadjuvant therapy. LD was measured by the site radiologist as the longest dimension of the enhanced area on early post-contrast images. Functional tumor volume (FTV) was assessed as the sum of voxels with enhancement above specific thresholds within the pre-defined region-of-interest (ROI). A linearized variable was derived to represent the combination of FTV and LD. The area under the receiver operating characteristic curve (AUC) was used to evaluate the assessment of treatment response, pathologic complete response (pCR), defined as no invasive disease in the breast and lymph nodes, and in-breast pCR, defined as no invasive disease in the breast only. The analysis was performed in the full cohort and in breast cancer subtype defined by hormone receptor status and HER2 status.
Results: Among the patient cohort of N=675 with FTV and LD, 247 (37%) did and 428 (41%) did not achieve pCR after neoadjuvant therapy. pCR rates varied among HR/HER2 subtypes (HR+/HER2-: 19%; HR+/HER2+: 38%; HR-/HER2+: 71%; HR-/HER2- (triple negative, TN): 43%). In-breast pathologic complete response rates were slightly higher in each group (full: 41%; HR+/HER2-: 23%; HR+/HER2+: 43%; HR-/HER2+: 72%; HR-/HER2-: 49%). Table 1 shows AUCs for assessing pCR using FTV alone, LD alone, and the variable combining FTV and LD. Higher AUCs were observed in all patient groups using the combined variable. AUC of 0.79 (95% CI: 0.77, 0.81) was observed for the combined variable to assess pCR in the full cohort. AUCs varied from 0.69 to 0.86 among HR/HER2 subgroups (HR+/HER2-: 0.69; HR+/HER2+: 0.74; HR-/HER2+: 0.86; HR-/HER2-: 0.80), with no difference in assessing pCR or in-breast pCR. The performance is best for the HR- subtypes.
Conclusions: Both FTV and LD can be used in the assessment of invasive disease residual after neoadjuvant therapy. The combined variable of FTV and LD achieved highest AUCs, compared to using individual variable alone. Tools to improve performance in the HR+ subsets are underway.
AUCs of MR measurements for identifying pCR FTV alone (95% CI)LD alone (95% CI)Combined (95% CI)FullWith subtype adj.0.73 (0.71, 0.75)0.77 (0.74, 0.79)0.79 (0.77, 0.81)FullWithout subtype adj0.69 (0.65, 0.73)0.72 (0.68, 0.76)0.75 (0.71, 0.79)HR+/HER2- 0.68 (0.60, 0.77)0.68 (0.59, 0.77)0.69 (0.61, 0.77)HR+/HER2+ 0.65 (0.56, 0.75)0.72 (0.64, 0.80)0.74 (0.66, 0.82)HR-/HER2+ 0.69 (0.55, 0.83)0.82 (0.71, 0.92)0.86 (0.77, 0.95)HR-/HER2- (TN) 0.72 (0.66, 0.79)0.73 (0.67, 0.80)0.80 (0.74, 0.85)
Citation Format: Li W, Newitt D, Yun BL, Kornak J, Joe B, Yau C, Abe H, Wolverton D, Crane E, Ward K, Nelson M, Niell B, Drukteinis J, Oh K, Brandt K, Bang DH, Ojeda H, Eghtedari M, Sheth P, Bernreuter W, Umphrey H, Rosen M, Dogan B, Yang W, Esserman L, Hylton N. MRI detection of residual disease following neoadjuvant chemotherapy (NAC) in the I-SPY 2 TRIAL [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD4-03.
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Affiliation(s)
- W Li
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - D Newitt
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - BL Yun
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - J Kornak
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - B Joe
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - C Yau
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - H Abe
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - D Wolverton
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - E Crane
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - K Ward
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - M Nelson
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - B Niell
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - J Drukteinis
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - K Oh
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - K Brandt
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - DH Bang
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - H Ojeda
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - M Eghtedari
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - P Sheth
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - W Bernreuter
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - H Umphrey
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - M Rosen
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - B Dogan
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - W Yang
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - L Esserman
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
| | - N Hylton
- University of California, San Francisco, San Francisco, CA; University of Chicago, Chicago, IL; University of Colorado, Denver, CO; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Minnesota, Minneapolis, MN; Moffitt Cancer Center, Tampa, FL; Oregon Health Science University, Portland, OR; Rochester Methodist Hospital, Rochester, MN; Swedish Medical Center, Seattle, WA; University of California, San Diego, San Diego, CA; University of Southern California, Los Angeles, CA; University of Alabama, Birmingham, AL; University of Pennsylvania, Philadelphia, PA; University of Texas Southwestern, Houston, TX; MD Anderson Cancer Center, Houston, TX
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25
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Rahbar H, Zhang Z, Chenevert TL, Romanoff J, Kitsch AE, Hanna LG, Harvey SM, Moy L, DeMartini WB, Dogan B, Yang WT, Wang LC, Joe BN, Oh KY, Neal CH, McDonald ES, Schnall MD, Lehman CD, Comstock CE, Partridge SC. Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702). Clin Cancer Res 2019; 25:1756-1765. [PMID: 30647080 DOI: 10.1158/1078-0432.ccr-18-2967] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives.Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. RESULTS Of 107 women enrolled, 67 patients (median age 49, range 24-75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n = 63) or 5 (n = 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm2/s) than benign lesions [1.21 × 10-3 vs.1.47 × 10-3; P < 0.0001; area under ROC curve = 0.75; 95% confidence interval (CI) 0.65-0.84]. In centralized analysis, application of an ADC threshold (1.53 × 10-3 mm2/s) lowered the biopsy rate by 20.9% (14/67; 95% CI, 11.2%-31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68 × 10-3 mm2/s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. CONCLUSIONS DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.
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Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Seattle, Washington.
| | - Zheng Zhang
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Averi E Kitsch
- University of Washington School of Medicine, Seattle, Washington
| | - Lucy G Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Sara M Harvey
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Linda Moy
- New York University School of Medicine, New York, New York
| | - Wendy B DeMartini
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Wei T Yang
- MD Anderson Cancer Center, Houston, Texas
| | - Lilian C Wang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bonnie N Joe
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Karen Y Oh
- Oregon Health Sciences University, Portland, Oregon
| | - Colleen H Neal
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Elizabeth S McDonald
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Constance D Lehman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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26
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Partridge SC, Zhang Z, Newitt DC, Gibbs JE, Chenevert TL, Rosen MA, Bolan PJ, Marques HS, Romanoff J, Cimino L, Joe BN, Umphrey HR, Ojeda-Fournier H, Dogan B, Oh K, Abe H, Drukteinis JS, Esserman LJ, Hylton NM. Diffusion-weighted MRI Findings Predict Pathologic Response in Neoadjuvant Treatment of Breast Cancer: The ACRIN 6698 Multicenter Trial. Radiology 2018; 289:618-627. [PMID: 30179110 PMCID: PMC6283325 DOI: 10.1148/radiol.2018180273] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 01/06/2023]
Abstract
Purpose To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ΔADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years ± 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2- disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ΔADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ΔADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P < .001). In a test subset, a model combining tumor subtype and midtreatment ΔADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ΔADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Savannah C. Partridge
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Zheng Zhang
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - David C. Newitt
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Jessica E. Gibbs
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Thomas L. Chenevert
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Mark A. Rosen
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Patrick J. Bolan
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Helga S. Marques
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Justin Romanoff
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Lisa Cimino
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Bonnie N. Joe
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Heidi R. Umphrey
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Haydee Ojeda-Fournier
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Basak Dogan
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Karen Oh
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Hiroyuki Abe
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Jennifer S. Drukteinis
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Laura J. Esserman
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Nola M. Hylton
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - For the ACRIN 6698 Trial Team and I-SPY 2 Trial Investigators
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
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27
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Newitt DC, Zhang Z, Gibbs JE, Partridge SC, Chenevert TL, Rosen MA, Bolan PJ, Marques HS, Aliu S, Li W, Cimino L, Joe BN, Umphrey H, Ojeda-Fournier H, Dogan B, Oh K, Abe H, Drukteinis J, Esserman LJ, Hylton NM. Test-retest repeatability and reproducibility of ADC measures by breast DWI: Results from the ACRIN 6698 trial. J Magn Reson Imaging 2018; 49:1617-1628. [PMID: 30350329 DOI: 10.1002/jmri.26539] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Quantitative diffusion-weighted imaging (DWI) MRI is a promising technique for cancer characterization and treatment monitoring. Knowledge of the reproducibility of DWI metrics in breast tumors is necessary to apply DWI as a clinical biomarker. PURPOSE To evaluate the repeatability and reproducibility of breast tumor apparent diffusion coefficient (ADC) in a multi-institution clinical trial setting, using standardized DWI protocols and quality assurance (QA) procedures. STUDY TYPE Prospective. SUBJECTS In all, 89 women from nine institutions undergoing neoadjuvant chemotherapy for invasive breast cancer. FIELD STRENGTH/SEQUENCE DWI was acquired before and after patient repositioning using a four b-value, single-shot echo-planar sequence at 1.5T or 3.0T. ASSESSMENT A QA procedure by trained operators assessed artifacts, fat suppression, and signal-to-noise ratio, and determine study analyzability. Mean tumor ADC was measured via manual segmentation of the multislice tumor region referencing DWI and contrast-enhanced images. Twenty cases were evaluated multiple times to assess intra- and interoperator variability. Segmentation similarity was assessed via the Sørenson-Dice similarity coefficient. STATISTICAL TESTS Repeatability and reproducibility were evaluated using within-subject coefficient of variation (wCV), intraclass correlation coefficient (ICC), agreement index (AI), and repeatability coefficient (RC). Correlations were measured by Pearson's correlation coefficients. RESULTS In all, 71 cases (80%) passed QA evaluation: 44 at 1.5T, 27 at 3.0T; 60 pretreatment, 11 after 3 weeks of taxane-based treatment. ADC repeatability was excellent: wCV = 4.8% (95% confidence interval [CI] 4.0, 5.7%), ICC = 0.97 (95% CI 0.95, 0.98), AI = 0.83 (95% CI 0.76, 0.87), and RC = 0.16 * 10-3 mm2 /sec (95% CI 0.13, 0.19). The results were similar across field strengths and timepoint subgroups. Reproducibility was excellent: interreader ICC = 0.92 (95% CI 0.80, 0.97) and intrareader ICC = 0.91 (95% CI 0.78, 0.96). DATA CONCLUSION Breast tumor ADC can be measured with excellent repeatability and reproducibility in a multi-institution setting using a standardized protocol and QA procedure. Improvements to DWI image quality could reduce loss of data in clinical trials. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1617-1628.
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Affiliation(s)
- David C Newitt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Zheng Zhang
- Department of Biostatistics, Brown University, Providence, Rhode Island, USA.,Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA.,American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA
| | - Jessica E Gibbs
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | - Thomas L Chenevert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark A Rosen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick J Bolan
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Helga S Marques
- Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA.,American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania, USA
| | - Sheye Aliu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Lisa Cimino
- American College of Radiology & ECOG-ACRIN Cancer Research Group, Philadelphia, Pennsylvania, USA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Heidi Umphrey
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | | | - Basak Dogan
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Houston, Texas, USA
| | - Karen Oh
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hiroyuki Abe
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Jennifer Drukteinis
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Women's Imaging, St. Joseph's Women's Hospital, Tampa, Florida, USA
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, California, USA
| | - Nola M Hylton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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28
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Ozener HO, Kundak K, Sipahi NG, Yetis E, Dogan B. Different treatment approaches for the localized gingival overgrowths: Case series. Eur J Dent 2018; 12:311-316. [PMID: 29988262 PMCID: PMC6004815 DOI: 10.4103/ejd.ejd_344_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Localized gingival overgrowths belong to a common group of lesions designated as focal reactive overgrowths. They occur in response to chronic, low-grade irritation caused by plaque or any other irritant. They have multifactorial etiopathology but exhibit similar clinical features with slight variations in patient complaints. Success of the lesions' management depends on formation of healthy contours of the surgical area after excision of lesion and absence of a recurrence. The purpose of case series is to present 6 different cases of localized gingival overgrowths and their management with the following techniques: nonsurgical periodontal treatment, gingivectomy, flap surgery, free gingival graft, gingival unit, and connective tissue graft.
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Affiliation(s)
- Hafize Ozturk Ozener
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkye
| | - Kubra Kundak
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkye
| | - Nimet Gul Sipahi
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkye
| | - Ece Yetis
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkye
| | - Basak Dogan
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkye
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29
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Wang C, Wei W, Santiago L, Whitman G, Dogan B. Can imaging kinetic parameters of dynamic contrast-enhanced magnetic resonance imaging be valuable in predicting clinicopathological prognostic factors of invasive breast cancer? Acta Radiol 2018; 59:813-821. [PMID: 29105486 DOI: 10.1177/0284185117740746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Intrinsic molecular profiling of breast cancer provides clinically relevant information that helps tailor therapy directed to the specific tumor subtype. We hypothesized that dynamic contrast-enhanced MRI (DCE-MRI) derived quantitative kinetic parameters (CD-QKPs) may help predict molecular tumor profiles non-invasively. Purpose To determine the association between DCE-MRI (CD-QKPs) and breast cancer clinicopathological prognostic factors. Material and Methods Clinicopathological factors in consecutive women with biopsy-confirmed invasive breast cancer who underwent breast DCE-MRI were retrospectively reviewed. Analysis of variance was used to examine associations between prognostic factors and CD-QKPs. Fisher's exact test was used to investigate the relationship between kinetic curve type and prognostic factors. Results A total of 198 women with invasive breast cancer were included. High-grade and HER2+ tumors were more likely to have a washout type curve while luminal A tumors were less likely. High-grade was significantly associated with increased peak enhancement (PE; P = 0.01), enhancement maximum slope (MS; P = 0.03), and mean enhancement ( ME, P = 0.03), while high clinical lymph node stage (cN3) was significantly associated with increased MS and time to peak (tP; P = 0.01). HER2+ tumors were associated with a higher PE ( P = 0.03) and ME ( P = 0.06) than HER2- counterparts, and ER-/HER2+ tumors showed higher PE and ME values than ER+/HER2- tumors ( P = 0.06). Conclusion DCE-MRI time-intensity CD-QKPs are associated with high tumor grade, advanced nodal stage, and HER2+ status, indicating their utility as imaging biomarkers.
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Affiliation(s)
- Cuiyan Wang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Shandong Medical Imaging Research Institute, Jinan, PR China
| | - Wei Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Whitman
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Basak Dogan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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30
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Lehrer M, Bhadra A, Aithala S, Ravikumar V, Zheng Y, Dogan B, Bonaccio E, Burnside ES, Morris E, Sutton E, Whitman GJ, Net J, Brandt K, Ganott M, Zuley M, Rao A. High-dimensional regression analysis links magnetic resonance imaging features and protein expression and signaling pathway alterations in breast invasive carcinoma. Oncoscience 2018; 5:39-48. [PMID: 29556516 PMCID: PMC5854291 DOI: 10.18632/oncoscience.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/15/2017] [Indexed: 12/27/2022] Open
Abstract
Background Imaging features derived from MRI scans can be used for not only breast cancer detection and measuring disease extent, but can also determine gene expression and patient outcomes. The relationships between imaging features, gene/protein expression, and response to therapy hold potential to guide personalized medicine. We aim to characterize the relationship between radiologist-annotated tumor phenotypic features (based on MRI) and the underlying biological processes (based on proteomic profiling) in the tumor. Methods Multiple-response regression of the image-derived, radiologist-scored features with reverse-phase protein array expression levels generated association coefficients for each combination of image-feature and protein in the RPPA dataset. Significantly-associated proteins for features were analyzed with Ingenuity Pathway Analysis software. Hierarchical clustering of the results of the pathway analysis determined which features were most strongly correlated with pathway activity and cellular functions. Results Each of the twenty-nine imaging features was found to have a set of significantly correlated molecules, associated biological functions, and pathways. Conclusions We interrogated the pathway alterations represented by the protein expression associated with each imaging feature. Our study demonstrates the relationships between biological processes (via proteomic measurements) and MRI features within breast tumors.
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Affiliation(s)
- Michael Lehrer
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Sathvik Aithala
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Visweswaran Ravikumar
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Youyun Zheng
- Department of Biostatistics, Emory University, Atlanta, GA, USA
| | - Basak Dogan
- Department of Radiology, UT Southwestern, Dallas, TX, USA
| | - Emerlinda Bonaccio
- Department of Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Elizabeth Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Sutton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary J Whitman
- Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jose Net
- Department of Radiology, University of Miami Health System, Miami, FL, USA
| | - Kathy Brandt
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Marie Ganott
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Margarita Zuley
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arvind Rao
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
e13049 Background: The American Cancer Society (ACS) recommends yearly breast MRI (BMRI) in addition to mammography for women with high breast cancer risk. However, standard BMRI protocols have a long acquisition time and consequently long interpretation time, which can reduce patient compliance and drive MRI cost. Therefore, we aimed to evaluate an American College of Radiology (ACR)-compliant short BMRI (SBMRI) protocol vis-à-vis compared with standard of care BMRI (SOC-BMRI) obtained in the same high-risk patient. To the best of our knowledge, a prospective study comparing both techniques does not exist. Our primary endpoint is to compare positive predictive value and cancer detection rate. Secondary endpoint is measuring and comparing patient experience between two techniques. As the study and accrual is ongoing and primary endpoint will be evaluated at the completion of accrual in a blinded fashion, here we report characteristics of patients who participated so far. Methods: This is a prospective HIPAA compliant and IRB approved trial. High risk women undergoing SOC-BMRI based on ACS screening guidelines signed an informed consent form to undergo an additional SBMRI within 7 days of the SOC-BMRI. Accrual target goal is 200 patients to give statistical power to estimate sensitivity and 95% confidence interval, with 10% or less expected to have breast cancer. Results: A total of 59 women were enrolled so far. Median age is 53 (range 26-72). Nine (15.3%) had BRCA1 or BRCA2 pathogenic mutations; 6 (10.2%) variant of uncertain significance (VUS). One (1.7%) had CDH1 pathogenic mutation, one (1.7%) had VUS in PALB2. Personal history of breast cancer was present in 2 (3.4%), atypical hyperplasia in 9 (15.3%), LCIS in 3 (5.1%), family history (FH) of breast cancer in 55 (93.2%). Hormone replacement therapy use was current in 2 (3.4%), past in 10 (16.9%). Use of raloxifene, tamoxifen, or aromatase inhibitors was current in 8 (13.6%), past in 5 (8.5%). Conclusions: In this BMRI study comparing SOC-BMRI versus SBMRI, the distribution of breast cancer risk factors reflects our routine cohort, with most patients screened based on FH of breast cancer. Clinical trial information: Primary ID 2015-0243 Secondary IDs NCI-2015-02031 Clinicaltrials.gov ID NCT02590458.
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Affiliation(s)
- Marion Scoggins
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Basak Dogan
- The University of Texas Southwestern, Dallas, TX
| | - Jingfei Ma
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Wei
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jong Bum Song
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Banu Arun
- MD Anderson Cancer Center, Houston, TX
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Dogan B, Dogan U, Erol MK, Habibi M, Oruc MT. Comparison of anterior segment parameter values obtained with Scheimpflug-Placido topographer, optical low coherence reflectometry and noncontact specular microscopy in morbid obesity. Eur Rev Med Pharmacol Sci 2017; 21:438-445. [PMID: 28239829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the measurement of anterior segment parameters using Sirius Scheimpflug-Placido topographer, Lenstar optical low coherence reflectometry (OLCR), and noncontact specular microscopy (SM) in morbidly obese and nonobese subjects. PATIENTS AND METHODS Twenty-eight morbidly obese subjects (BMI ≥ 40; Group 1) and 28 age- sex-matched healthy nonobese subjects (BMI 18.50-24.99; Group 2) were included in this study. Anterior segment parameters were measured by Scheimpflug-Placido topographer and OLCR. Corneal endothelial cell parameters were measured by non-contact SM. The group data were analyzed using the Mann-Whitney U test and Student's t-test. Bland-Altman plots were used to assess agreement among the instruments, and 95% limits of agreement (LoA) for each comparison were calculated. RESULTS In group 1, the mean CCT by Scheimpflug-Placido topographer, OLCR, and noncontact SM were 549.44±30.10 µm, 544.15±31.48 µm, and 541.59±29.87 µm respectively. In group 2, the mean CCT by Scheimpflug-Placido topographer, OLCR, and noncontact SM were 531.0±22.09 µm, 523.15±21.39 µm, and 521.12±21.70 µm respectively. Mean CCT values obtained by the three methods were significantly higher in the morbidly obese than the nonobese subjects. In both groups, mean CCT was significantly higher when measured by Scheimpflug-Placido topographer than by OLCR and noncontact SM, and mean AD and ACD were significantly higher when measured by Scheimpflug-Placido topographer than OLCR. No significant differences were found between mean corneal curvature and corneal astigmatism when measured by Scheimpflug-Placido topographer and OLCR. CONCLUSIONS The mean CCT of the morbidly obese subjects were significantly higher than the nonobese subjects when measured by all three methods. The CCT values obtained by Scheimpflug-Placido topographer were significantly higher than those by OLCR and SM.
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Affiliation(s)
- B Dogan
- Department of Ophthalmology, Department of General Surgery; Antalya Training and Research Hospital, Antalya, Turkey.
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Erol M, Balkarli A, Toslak D, Durmaz D, Dogan B, Baskan E, Altun S, Bulut M, Cobankara V. FRI0540 Evaluation of Nailfoldvideocapillaroscopy in Central Serous Chorioretinopathy: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ma J, Son J, Arun B, Hazle J, Hwang K, Wang K, Bayram E, Madewell J, Yang W, Dogan B. SU-F-I-16: Short Breast MRI with High-Resolution T2-Weighted and Dynamic Contrast Enhanced T1-Weighted Images. Med Phys 2016. [DOI: 10.1118/1.4955844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dogan B, Kazim Erol M, Dogan U, Habibi M, Bulbuller N, Turgut Coban D, Bulut M. The retinal nerve fiber layer, choroidal thickness, and central macular thickness in morbid obesity: an evaluation using spectral-domain optical coherence tomography. Eur Rev Med Pharmacol Sci 2016; 20:886-891. [PMID: 27010146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the effect of morbid obesity on retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), retinal ganglion cell (RGC), choroidal thickness (CT), central corneal thickness (CCT), and intraocular pressure (IOP). PATIENTS AND METHODS Sixty-seven patients defined as having morbid or class III obesity (BMI ≥ 40; Group 1) scheduled to undergo sleeve gastrectomy surgery and 29 nonobese patients (BMI 18.50-24.99; Group 2) underwent complete ophthalmic examination for measurement of IOP, CT, RNFL thickness, CMT, RGC, and CCT. RNFL thickness, CMT, and RGC were measured using spectral-domain optical coherence tomography (SD-OCT). CT measurement was performed using the enhanced depth imaging technique of the SD-OCT. The group data were analyzed and compared using the Mann-Whitney U test and Student's t-test. The relationship between the clinical ocular variables and obesity was analyzed using the Spearman's rank correlation test. RESULTS The mean IOP and CCT of Group 1 were found to be significantly higher (p < 0.001) and the mean RNFL, RGC, and CT significantly lower (p < 0.05) than those of Group 2. While Group 2 was found to have a slightly larger cup-to-disc ratio and Group 1 to have a thinner CMT, the differences between Groups 1 and 2 regarding these variables were not found to be statistically significant (p = 0.322 and p = 0.072, respectively). The results of Spearmen correlation analysis indicated the existence of a moderately positive correlation between IOP and BMI (p < 0.001; r = 0.5-0.6). CONCLUSIONS We have demonstrated by SD-OCT that morbid obesity may have a significant influence on RNFL, RGC, and CT. Morbid obesity may induce inflammatory, hormonal, and metabolic changes.
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Affiliation(s)
- B Dogan
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey.
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Mittendorf EA, Dogan B, Morgan R, Chargin A, Wu Y, Cornett-Risher S, Shults K. Abstract P1-01-17: Integrative pathology: Analysis of cellular multiplex technology to detect proteomic, genomic and DNA data from fine needle aspiration biopsy specimens. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-01-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: An integrative system capable of detecting proteomic, genomic and DNA content from cell isolates obtained by fine needle aspiration (FNA) biopsy may offer distinct advantages in diagnosing breast cancer and monitoring response to therapy. Cellular Multiplex™ is such a system. An initial pilot study evaluating this technology established a series of variables that could separate normal from cancerous elements using cells obtained from an FNA performed on excised tumors and reduction mammoplasty specimens. In order for the technology to be clinically relevant, it must perform robustly on intact tumors. The current study was therefore undertaken to validate Cellular Multiplex™ on cells obtained by FNA performed on intact tumor at the time of diagnosis.
Methods: Patients undergoing lumpectomy requiring either needle or 125I seed localization were identified. FNA was performed on intact tumor (A samples) at the time of radiographic localization prior to lumpectomy and repeated on the excised tumor (B samples). Cells obtained by FNA were placed in a proprietary fixative then hybridized and stained to detect multiple mRNA and protein targets along with DNA content. Estrogen receptor, progesterone receptor and HER2 were included in the panel of targets and compared to the routine clinical pathology report. Cell morphology was assessed by mean corpuscular volume. Samples were analyzed using an EC800 (Sony Biotechnology, San Jose, CA) and the results from matched A and B samples were compared using the Mann-Whitney Wilcoxson Rank Sum test. The study is designed to enroll 50 patients. Here we report an analysis of the first 9 cases.
Results: The cell number obtained from the excised tumors were 3-4 times greater (median to median) than obtained from the intact tumor. There was no statistical difference in the expression of the 2 mRNA targets, 8 protein targets, DNA content and cell morphology between the A and B samples. The parameters derived from Cellular Multiplex matched the standard pathologic features reported on the clinical pathology report in 8 of 9 cases. In the one discrepant case, Cellular Multiplexing detected ER positive cells in a case where standard pathologic evaluation with immunohistochemistry reported the tumor to be estrogen receptor negative.
Conclusions: This interim analysis demonstrates that the Cellular Multiplex technology is working well using cells obtained by FNA performed on intact tumors with readouts matching those obtained from excised specimens. If confirmed in the remaining patients, these data suggest that this technology will be applicable for the evaluation of intact tumors thereby making it relevant for multiple clinical indications including diagnosis and monitoring response to neoadjuvant therapy.
Citation Format: Mittendorf EA, Dogan B, Morgan R, Chargin A, Wu Y, Cornett-Risher S, Shults K. Integrative pathology: Analysis of cellular multiplex technology to detect proteomic, genomic and DNA data from fine needle aspiration biopsy specimens. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-17.
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Affiliation(s)
- EA Mittendorf
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
| | - B Dogan
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
| | - R Morgan
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
| | - A Chargin
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
| | - Y Wu
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
| | - S Cornett-Risher
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
| | - K Shults
- The University of Texas MD Anderson Cancer Center, Houston, TX; Penfold-Patterson Research Institute, Frankfort, MI
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Rao A, Net J, Brandt K, Huang E, Freymann J, Burnside E, Kirby J, Morris E, Bonaccio E, Giger M, Jaffe C, Ganott M, Sutton E, Le-Petross H, Zuley M, Dogan B, Whitman G. TU-CD-BRB-07: Identification of Associations Between Radiologist-Annotated Imaging Features and Genomic Alterations in Breast Invasive Carcinoma, a TCGA Phenotype Research Group Study. Med Phys 2015. [DOI: 10.1118/1.4925592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dogan U, Dogan B, Habibi M, Erol MK, Mayir B, Aslaner A, Bulbuller N. Ileal J-Pouch Perforation: Case Report. Chirurgia (Bucur) 2015; 110:291-3. [PMID: 26158741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 10/18/2022]
Abstract
A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.
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Caudle AS, Yang WT, Mittendorf EA, Black DM, Gilcrease M, Bedrosian I, Hobbs BP, Candelaria RP, Babiera G, Dogan B, Santiago L, Hunt K, Krishnamurthy S, Kuerer HM. Assessment for residual nodal disease after neoadjuvant chemotherapy with image-guided surgery. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
99 Background: Staging of breast cancer patients is enhanced by axillary ultrasound (US) and needle biopsy of abnormal lymph nodes (LN). When clips are placed in sampled metastatic LNs, they can be evaluated for nodal response to neoadjuvant chemotherapy (NCT). The goals of this study were to determine if pathologic changes in clipped LNs reflect nodal response to NCT and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) in addition to selective localization and removal of clipped LNs, could increase the accuracy of nodal assessment. Methods: This prospective study included patients with US-identified axillary metastases confirmed by needle biopsy with a clip placed in the sampled LN. After NCT, patients underwent axillary lymphadenectomy (ALND) with x-ray of the axillary contents to identify the clip-containing LN. In 38 patients, the clipped LN was selectively removed using wire (n=2) or I125seed localization (n=36) before ALND was performed. Five patients did not undergo ALND. The pathologic findings of the clipped LN were reported separately from the other nodes. Results: Ninety node positive patients were enrolled. Forty (44%) had a complete nodal response to NCT and 50 (56%) had residual disease. Pathologic evaluation of the clipped LN revealed metastases in 47/50 patients with residual disease, resulting in a false negative rate (FNR) of 6% (95% CI 1.3-16.6). In 52 patients who underwent SLND, the clipped LN was not a SLN in 23% (n=12). Thirty-one of these patients had residual disease; metastases were not seen in SLNs in 5 cases resulting in a FNR for SLND alone of 16% (95% CI 5.4-34). Evaluation of the clipped LN in addition to SLND improved the FNR to 3% (1/31, 95% CI 0.1-17). Thirty-one patients underwent TAD while an additional 7 had localization and selective removal of the clipped LN without SLND with one false negative result. Conclusions: US-guided marking of LNs with documented metastatic disease allows for their selective removal and improved pathologic evaluation for residual nodal disease. The FNR of SLND can be reduced by ensuring removal and evaluation of the clipped LN. TAD is technically feasible and allows for improved assessment of nodal response after NCT.
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Affiliation(s)
| | - Wei Tse Yang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Brian P Hobbs
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Gildy Babiera
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Basak Dogan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kelly Hunt
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Gunduz M, Acar M, Fakioglu K, Dogan B, Oznur M, Gunduz E. 288: Effect of boric acid on head and neck cancer cell lines. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Manchester AC, Hill S, Sabatino B, Armentano R, Carroll M, Kessler B, Miller M, Dogan B, McDonough SP, Simpson KW. Association between granulomatous colitis in French Bulldogs and invasive Escherichia coli and response to fluoroquinolone antimicrobials. J Vet Intern Med 2012. [PMID: 23206120 DOI: 10.1111/jvim.12020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND French Bulldogs develop a form of granulomatous colitis (GC) with histopathological resemblance to GC of Boxer dogs (GCB). GCB is associated with mucosally invasive Escherichia coli whose eradication correlates with clinical remission. HYPOTHESIS/OBJECTIVES To characterize the clinical and histopathological features, presence or absence of invasive colonic bacteria, and response to fluoroquinolones in French Bulldogs with GC. ANIMALS A total of 6 French Bulldogs with a histological diagnosis of GC. METHODS Retrospective study of medical records. Bacterial colonization was evaluated using 16S rRNA probes for eubacteria and E. coli. Biopsy specimens from 3 dogs were cultured for bacteria. Clinical response to fluoroquinolone antimicrobials was determined. RESULTS All dogs were ≤1 year of age with hematochezia that was refractory to empirical therapy. Clinicopathologic and fecal analysis did not reveal abnormalities. Abdominal ultrasound revealed patchy thickening of the colon in 4/5 dogs and regional lymphadenopathy in 5/5. Colonoscopic abnormalities included irregularly thickened and ulcerated mucosa, hyperemia, and overt bleeding in 4/6 cases. Multifocal accumulations of PAS-positive macrophages and intramucosal E. coli were present in colonic biopsies of all 6 dogs. Administration of enrofloxacin (5/6) or marbofloxacin (1/6) at 4.4-10 mg/kg (median 10 mg/kg) PO q24h for 6-10 weeks was associated with clinical improvement within 5-14 days. All dogs remained in remission over a 3-30 month follow-up period. CONCLUSIONS Granulomatous colitis in young French Bulldogs is associated with the presence of invasive E. coli and closely parallels GCB. Treatment with fluoroquinolone antimicrobials can induce lasting clinical remission.
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Affiliation(s)
- A C Manchester
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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Yildiz S, Dogan B. Self reported dental health attitudes and behaviour of dental students in Turkey. Eur J Dent 2011; 5:253-9. [PMID: 21769265 PMCID: PMC3137437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the differences in self-reported oral health attitudes and behaviour between preclinical and clinical dental students in Turkey using Hiroshima University Dental Behavioural Inventory (HU-DBI). METHODS A Turkish version HU-DBI questionnaire with additional 7 questions, totally 27 items, was distributed among 1022 dental students. RESULTS The response rate was 75% (486 preclinical and 278 clinical students). Significantly higher (P=0.000) percentage of the preclinical students, compared to clinical students, worry about colour of their teeth, are bothered by the colour of their gums, put off going to the dentist until they have a toothache; think that their teeth are getting worse despite their daily brushing, it is impossible to prevent gum disease with tooth brushing alone, and they cannot help having false teeth when they are old. Moreover, the preclinical students more frequently agree on that their gums tend to bleed when they brush their teeth, they use a toothbrush which has hard bristles, and they don't feel they've brushed well unless with strong strokes (P=0.000). However, a higher proportion of clinical students compared to preclinical students brush each of their teeth carefully, think that they can clean their teeth without using toothpaste, have had their dentist tell them that they brush very well (P=0.000). The HU-DBI score of clinical students (7.47±1.86) was significantly (P=0.000) higher than preclinical students (6.00±1.86). CONCLUSIONS Dental students should have a comprehensive program, including their self-care regimes, starting from their first year of education.
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Affiliation(s)
- Sinem Yildiz
- Marmara University, Faculty of Dentistry, Department of Periodontology, Istanbul, Turkey
| | - Basak Dogan
- Marmara University, Faculty of Dentistry, Department of Periodontology, Istanbul, Turkey,Corresponding author: Basak Dogan, Marmara University, Faculty of Dentistry, Department of Periodontology Buyuk Ciftlik Sokak No:6 34365 Nisantasi, Sisli, Istanbul, Turkey. Phone: +90 212 2319120, Fax: +90 212 2465247, E-mail:
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Cohen L, Chen Z, Arun B, Shao Z, Dryden M, Xu L, Le-Petross C, Dogan B, McKenna BJ, Markman M, Babiera G. External qigong therapy for women with breast cancer prior to surgery. Integr Cancer Ther 2011; 9:348-53. [PMID: 21106615 DOI: 10.1177/1534735410387424] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED The majority of patients with cancer use some form of complementary or alternative medicine. External qigong treatment (EQT), classified as a bioenergy therapy, is one such approach that patients combine with conventional medicine or, in some cases, use in place of conventional medicine. This study aimed to determine whether EQT could shrink breast cancer tumors and improve quality of life (QOL) in women with pathologically confirmed breast cancer awaiting surgery. A total of 9 women with pathologically confirmed breast cancer were recruited from large cancer centers in the United States (n = 5) and China (n = 4). A single-arm pre/post design was used. Each patient underwent 5 consecutive days of EQT, with each treatment lasting from 2 to 5 minutes. All treatments were performed by the same qigong master. Tumor measurements were made before and after the EQT sessions. Tumor assessments were conducted prior to study initiation and following the last EQT. Patients underwent both an ultrasound and mammogram (United States) or an ultrasound and magnetic resonance imaging (China). All patients also underwent physical breast examinations (PBEs) and completed QOL questionnaires before and after the last EQT. No clinical changes in tumor measurements from pre- to post-EQT were noted. There was also no suggestion of change in tumor size by PBE or change in QOL. Using the current STUDY DESIGN EQT also does not appear to have any effect on patient QOL. Because of the small sample size and working with only one qigong practitioner, to definitively determine the efficacy or lack of efficacy of EQT, a larger study with multiple qigong practitioners would need to be conducted.
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Affiliation(s)
- Lorenzo Cohen
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77230, USA.
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Craven M, Dogan B, Schukken A, Volkman M, Chandler A, McDonough PL, Simpson KW. Antimicrobial resistance impacts clinical outcome of granulomatous colitis in boxer dogs. J Vet Intern Med 2010; 24:819-24. [PMID: 20492483 DOI: 10.1111/j.1939-1676.2010.0527.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Escherichia coli have recently been identified within the colonic mucosa of Boxer dogs with granulomatous colitis (GC). Eradication of invasive E. coli is associated with clinical and histological remission. OBJECTIVES To determine antimicrobial susceptibility profiles of E. coli strains from GC and healthy dogs, and the association of antimicrobial resistance with clinical outcome. ANIMALS Fourteen Boxer dogs with GC and 17 healthy pet dogs. METHODS Prospective study: E. coli was cultured from GC biopsies and rectal mucosal swabs of healthy dogs. Individual strains were selected by phylogroup and overall genotype, determined by triplex- and random amplified polymorphic DNA-polymerase chain reaction respectively. Antimicrobial susceptibility was determined by broth microdilution minimal inhibitory concentration. RESULTS Culture yielded 23 E. coli strains from GC (1-3/dog, median 2) and 34 strains from healthy (1-3/dog, median 2). E. coli phylogroups were similar (P=.18) in GC (5A, 7B1, 5B2, 6D) and healthy (2A, 10B1, 15B2, 7D). Resistance to ampicillin, amoxicillin-clavulanate, cefoxitin, tetracycline, trimethoprim-sulfa (TMS), ciprofloxacin, and chloramphenicol was greater (P<.05) in GC (21-64%) than healthy (0-24%). Enrofloxacin resistant E. coli were isolated from 6/14 GC versus 0/17 healthy (P=.004). Of the enrofloxacin resistant cases, 4/6 were also resistant to macrophage-penetrating antimicrobials such as chloramphenicol, rifampicin, and TMS. Enrofloxacin treatment before definitive diagnosis was associated with antimicrobial resistance (P<.01) and poor clinical outcome (P<.01). CONCLUSIONS AND CLINICAL IMPORTANCE Antimicrobial resistance is common among GC-associated E. coli and impacts clinical response. Antimicrobial therapy should be guided by mucosal culture and antimicrobial susceptibility testing rather than empirical wisdom.
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Affiliation(s)
- M Craven
- College of Veterinary Medicine, VMC 2001, Cornell University, Ithaca, NY 14853-9655, USA
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Bölke E, Orth K, Gerber PA, Lammering G, Mota R, Peiper M, Matuschek C, Budach W, Rusnak E, Shaikh S, Dogan B, Prisack HB, Bojar H. Gene expression of circulating tumour cells in breast cancer patients. Eur J Med Res 2009; 14:426-32. [PMID: 19748849 PMCID: PMC3352225 DOI: 10.1186/2047-783x-14-10-426] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background The diagnostic tools to predict the prognosis in patients suffering from breast cancer (BC) need further improvements. New technological achievements like the gene profiling of circulating tumour cells (CTC) could help identify new prognostic markers in the clinical setting. Furthermore, gene expression patterns of CTC might provide important informations on the mechanisms of tumour cell metastasation. Materials and methods We performed realtime-PCR and multiplex-PCR analyses following immunomagnetic separation of CTC. Peripheral blood (PB) samples of 63 patients with breast cancer of various stages were analyzed and compared to a control group of 14 healthy individuals. After reverse-transcription, we performed multiplex PCR using primers for the genes ga733.3, muc-1 and c-erbB2. Mammaglobin1, spdef and c-erbB2 were analyzed applying realtime-PCR. Results ga733.2 overexpression was found in 12.7% of breast cancer cases, muc-1 in 15.9%, mgb1 in 9.1% and spdef in 12.1%. In this study, c-erbB2 did not show any significant correlation to BC, possibly due to a highly ambient expression. Besides single gene analyses, gene profiles were additionally evaluated. Highly significant correlations to BC were found in single gene analyses of ga733.2 and muc-1 and in gene profile analyses of ga733.3*muc-1 and GA7 ga733.3*muc-1*mgb1*spdef. Conclusion Our study reveals that the single genes ga733.3, muc-1 and the gene profiles ga733.3*muc-1 and ga733.3*3muc-1*mgb1*spdef can serve as markers for the detection of CTC in BC. The multigene analyses found highly positive levels in BC patients. Our study indicates that not single gene analyses but subtle patterns of multiple genes lead to rising accuracy and low loss of specificity in detection of breast cancer cases.
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Affiliation(s)
- E Bölke
- Department of Radiation Therapy and Radiation Oncology, University of Düsseldorf, Düsseldorf, Germany
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Boelke E, Bojar H, Prisack H, Matuschek C, Budach W, Gripp S, Peiper M, Dogan B. Circulating Tumor Cells during Radiotherapy in Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dogan B, Dallar Y, Bostancı I, Bozdayi G, Basbay Y, Battaloglu N, Rota S, Nizono A, Ahmed K. PVII-11 Rotavirus associated intussusception followed by spontaneous reduction. J Clin Virol 2009. [DOI: 10.1016/s1386-6532(09)70191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bozdayi G, Dinc B, Dogan B, Dallar Y, Dalgic B, Rota S, Nishizono A, Ahmed K. OP1-7 Molecular epidemiology of rotavirus in children aged between 0–5 years old in Turkey. J Clin Virol 2009. [DOI: 10.1016/s1386-6532(09)70041-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mansfield CS, James FE, Craven M, Davies DR, O'Hara AJ, Nicholls PK, Dogan B, MacDonough SP, Simpson KW. Remission of histiocytic ulcerative colitis in Boxer dogs correlates with eradication of invasive intramucosal Escherichia coli. J Vet Intern Med 2009; 23:964-9. [PMID: 19678891 DOI: 10.1111/j.1939-1676.2009.0363.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Historically, histiocytic ulcerative (HUC) (or granulomatous) colitis of Boxer dogs was considered an idiopathic immune-mediated disease with a poor prognosis. Recent reports of dramatic responses to enrofloxacin and the discovery of invasive Escherichia coli within the colonic mucosa of affected Boxer dogs support an infectious etiology. HYPOTHESIS Invasive E. coli is associated with colonic inflammation in Boxer dogs with HUC, and eradication of intramucosal E. coli correlates with clinical and histologic remission. ANIMALS Seven Boxer dogs with HUC. METHODS Prospective case series. Colonic biopsies were obtained at initial evaluation in 7 dogs, and in 5 dogs after treatment with enrofloxacin. Biopsies were evaluated by standardized histopathology, and fluorescence in situ hybridization (FISH) with probes to eubacteria and E. coli. RESULTS Intramucosal E. coli was present in colonic biopsies of 7/7 Boxers with HUC. Clinical response was noted in all dogs within 2 weeks of enrofloxacin (7 + or - 3.06 mg/kg q24 h, for 9.5 + or - 3.98 weeks) and was sustained in 6 dogs (median disease-free interval to date of 47 months, range 17-62). FISH was negative for E. coli in 4/5 dogs after enrofloxacin. E. coli resistant to enrofloxacin were present in the FISH-positive dog that relapsed. CONCLUSIONS AND CLINICAL RELEVANCE The correlation between clinical remission and the eradication of mucosally invasive E. coli during treatment with enrofloxacin supports the causal involvement of E. coli in the development of HUC in susceptible Boxer dogs. A poor response to enrofloxacin treatment might be due to colonization with enrofloxacin-resistant E. coli.
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Affiliation(s)
- C S Mansfield
- School of Veterinary and Biomedical Sciences, Murdoch University, Murdoch, WA 6150, Australia.
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