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Sella T, Simor B, Adler-Levy Y, Maly B, Kadouri L, Carmon E. MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach? Eur Radiol 2023; 33:7168-7177. [PMID: 37086288 DOI: 10.1007/s00330-023-09640-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/19/2022] [Revised: 01/24/2023] [Accepted: 02/16/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Current surgical policy recommends comprehensive excision of tumorous calcifications in breast cancer patients following neoadjuvant chemotherapy (NAC) regardless of MRI outcomes, despite MRI defining tumor response superior to mammography. The current study examines MRI prediction of response in tumors with vs without calcifications, using post-NAC surgical pathology as the standard of reference. METHODS Retrospective analysis of 114 NAC patients between 2011 and 2018 including demographics, mammography, 3 T-MRI, and pathology compared two sub-groups: without (n = 62) or with (n = 52) mammographic calcifications. In the calcification cohort, the mammographic extent of calcifications and MRI enhancement overlapped. MRI prediction of response to NAC was correlated with pathology. Two-tailed paired T and Fisher's exact tests and Cohen's kappa coefficient were applied for analysis. RESULTS There was no significant difference between the two sub-groups regarding demographics. Tumors demonstrated equivalent features regarding size, lymph node involvement, and DCIS component. ER-negative/HER2-positive tumors more commonly exhibited calcifications (33% n = 17 calcified vs 13% n = 8 non-calcified; p < 0.05); triple negative pathology rarely calcified (6% n = 3 calcified vs 33% n = 20 non-calcified; p < 0.05). NME was more common with calcifications (62% n = 32 calcified vs 29% n = 18 non-calcified; p < 0.05) and mass enhancement without (90% n = 56 non-calcified vs 81% n = 42 calcified; p < 0.05). Both groups responded similarly to NAC (pCR = 37% non-calcified vs 38% calcified); response on MRI equally correlated with pathology (69% both subgroups; p = 0.988). CONCLUSION We propose utilizing post-NAC MRI findings rather than mammography in planning surgery, as MRI prediction is independent of the presence or absence of calcifications. Prospective studies to evaluate this approach are warranted. KEY POINTS • No difference was found in demographic, clinical, pathology, or imaging characteristics between patients with or without tumoral calcifications on mammography prior to neoadjuvant chemotherapy. • Residual mammographic calcifications are inadequate predictors of residual invasive disease. MRI accurately recognized complete response and correctly correlated with post-treatment surgical pathology in 69% of patients, regardless of the presence or absence of mammographic calcifications. • We propose utilizing post-NAC MRI findings rather than mammography in planning post-NAC surgery, as MRI prediction of response is independent of the presence or absence of calcifications.
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Affiliation(s)
- Tamar Sella
- Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
- Hebrew University Medical School, Jerusalem, Israel.
| | - Bar Simor
- Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
- Hebrew University Medical School, Jerusalem, Israel
- Department of Pediatrics, Haim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Adler-Levy
- Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
- Hebrew University Medical School, Jerusalem, Israel
| | - Bella Maly
- Hebrew University Medical School, Jerusalem, Israel
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Luna Kadouri
- Hebrew University Medical School, Jerusalem, Israel
- Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Einat Carmon
- Department of Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Ben Gurion University Medical School, Beer Sheva, Israel
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Schiaffino S, Pinker K, Cozzi A, Magni V, Athanasiou A, Baltzer PAT, Camps Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Gilbert FJ, Helbich T, Kilburn-Toppin F, Kuhl CK, Lesaru M, Mann RM, Panizza P, Pediconi F, Sardanelli F, Sella T, Thomassin-Naggara I, Zackrisson S, Pijnappel RM. European Society of Breast Imaging (EUSOBI) guidelines on the management of axillary lymphadenopathy after COVID-19 vaccination: 2023 revision. Insights Imaging 2023; 14:126. [PMID: 37466753 DOI: 10.1186/s13244-023-01453-2] [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] [Received: 03/01/2023] [Accepted: 05/14/2023] [Indexed: 07/20/2023] Open
Abstract
Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach. As of 2023, according to newly acquired evidence, EUSOBI proposes the following updates, in order to reduce unnecessary examinations and avoid delaying necessary examinations. First, recommendation n. 3 has been revised to state that breast examinations should not be delayed or rescheduled because of COVID-19 vaccination, as evidence from the first pandemic waves highlights how delayed or missed screening tests have a negative effect on breast cancer morbidity and mortality, and that there is a near-zero risk of subsequent malignant findings in asymptomatic patients who have unilateral lymphadenopathy and no suspicious breast findings. Second, recommendation n. 7 has been revised to simplify follow-up strategies: in patients without breast cancer history and no imaging findings suspicious for cancer, symptomatic and asymptomatic imaging-detected unilateral lymphadenopathy on the same side of recent COVID-19 vaccination (within 12 weeks) should be classified as a benign finding (BI-RADS 2) and no further work-up should be pursued. All other recommendations issued by EUSOBI in 2021 remain valid.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Pascal A T Baltzer
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Thomas Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Carmon E, Alster T, Maly B, Kadouri L, Kleinman TA, Sella T. Preoperative MRI for evaluation of extent of disease in IDC compared to ILC. Clin Breast Cancer 2022; 22:e745-e752. [DOI: 10.1016/j.clbc.2022.07.007] [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] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
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Mann RM, Athanasiou A, Baltzer PAT, Camps-Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Helbich TH, Killburn-Toppin F, Lesaru M, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Sardanelli F, Sella T, Thomassin-Naggara I, Zackrisson S, Gilbert FJ, Kuhl CK. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol 2022; 32:4036-4045. [PMID: 35258677 PMCID: PMC9122856 DOI: 10.1007/s00330-022-08617-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. KEY POINTS: • The recommendations in Figure 1 summarize the key points of the manuscript.
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Affiliation(s)
- Ritse M Mann
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands.
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands.
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Julia Camps-Herrero
- Hospitales Ribera Salud, Avda.Cortes Valencianas, 58, 46015, Valencia, Spain
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine &; Klinikum Rechts der Isar, Technical University of Munich, Munich (TUM), Ismaninger Str. 22, 81675, München, Germany
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Fleur Killburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB20QQ, UK
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Carol Davila University, Bucharest, Romania
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele,, Via Olgettina 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB20QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße30, 52074, Aachen, Germany
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Shraga S, Grinshpun A, Zick A, Kadouri L, Cohen Y, Maimon O, Adler-Levy Y, Zeltzer G, Granit A, Maly B, Carmon E, Meiner V, Sella T, Hamburger T, Peretz T. "High-Risk Breast Cancer Screening in BRCA1/2 Carriers Leads to Early Detection and Improved Survival After a Breast Cancer Diagnosis". Front Oncol 2021; 11:683656. [PMID: 34540661 PMCID: PMC8443779 DOI: 10.3389/fonc.2021.683656] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Germline BRCA1/2 pathogenic variant (PV) carriers have high lifetime risk of developing breast cancer and therefore subjected to intense lifetime screening. However, solid data on the effectiveness of high-risk screening of the BRCA1/2 carrier population is limited. PATIENTS AND METHODS Retrospectively, we analyzed 346 women diagnosed with breast tumors. Patients were divided according to the timing of BRCA1/2 PVrecognition, before (BRCA-preDx awareness, N = 62) or after (BRCA-postDx awareness group, N = 284) cancer diagnosis. RESULTS Median follow-up times were 131.42 and 93.77 months in the BRCA-preDx awareness and BRCA-postDx awareness groups, respectively. In the BRCA-preDx awareness group, 78.7% of the patients had invasive tumors and 21.3% were diagnosed with pure ductal carcinoma in situ. In contrast, in the BRCA-postDx awareness group over 93% of women were diagnosed with invasive cancer and only 6.4% had in situ disease. The mode of tumor detection differed significantly between the groups: 71.9% in the BRCA-postDx awareness group and 26.2% in the BRCA-preDx awareness group were diagnosed after personally palpating a lump. Tumor size and nodal involvement were significantly more favorable in the BRCA-preDx awareness group. T stage was significantly lower in the BRCA-preDx awareness group: 54.84% at T1 and 20.96% at Tis. In the BRCA-postDx awareness group, only 37.54% were at T1 and 6.49% at Tis. The N stage was also significantly lower in the BRCA-preDx awareness group: 71% had no lymph node metastases, compared with 56.1% in the BRCA-postDx awareness group. Additionally, therapeutic procedures varied between the groups: BRCA-preDx awareness group patients underwent more breast conserving surgeries. Axillary lymph node dissection was done in 38% of women in the BRCA-postDx awareness group and in only 8.7% of the BRCA-preDx awareness group patients. Interestingly, improved survival was found among patients who underwent high-risk screening (hazard ratio=0.34). CONCLUSIONS High-risk screening might facilitate downstaging of detected breast tumor among BRCA1/2 carrier population.
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Affiliation(s)
- Shay Shraga
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviad Zick
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Luna Kadouri
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yogev Cohen
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofra Maimon
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Adler-Levy
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Radiology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Galina Zeltzer
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Radiology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avital Granit
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bella Maly
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Pathology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Einat Carmon
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vardiella Meiner
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Genetic and Metabolic Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tamar Sella
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Radiology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tamar Hamburger
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Schiaffino S, Pinker K, Magni V, Cozzi A, Athanasiou A, Baltzer PAT, Camps Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Helbich TH, Kilburn-Toppin F, Kuhl CK, Lesaru M, Mann RM, Panizza P, Pediconi F, Pijnappel RM, Sella T, Thomassin-Naggara I, Zackrisson S, Gilbert FJ, Sardanelli F. Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI). Insights Imaging 2021; 12:119. [PMID: 34417642 PMCID: PMC8378785 DOI: 10.1186/s13244-021-01062-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 05/17/2021] [Accepted: 07/17/2021] [Indexed: 01/12/2023] Open
Abstract
Unilateral axillary lymphadenopathy is a frequent mild side effect of COVID-19 vaccination. European Society of Breast Imaging (EUSOBI) proposes ten recommendations to standardise its management and reduce unnecessary additional imaging and invasive procedures: (1) in patients with previous history of breast cancer, vaccination should be performed in the contralateral arm or in the thigh; (2) collect vaccination data for all patients referred to breast imaging services, including patients undergoing breast cancer staging and follow-up imaging examinations; (3) perform breast imaging examinations preferentially before vaccination or at least 12 weeks after the last vaccine dose; (4) in patients with newly diagnosed breast cancer, apply standard imaging protocols regardless of vaccination status; (5) in any case of symptomatic or imaging-detected axillary lymphadenopathy before vaccination or at least 12 weeks after, examine with appropriate imaging the contralateral axilla and both breasts to exclude malignancy; (6) in case of axillary lymphadenopathy contralateral to the vaccination side, perform standard work-up; (7) in patients without breast cancer history and no suspicious breast imaging findings, lymphadenopathy only ipsilateral to the vaccination side within 12 weeks after vaccination can be considered benign or probably-benign, depending on clinical context; (8) in patients without breast cancer history, post-vaccination lymphadenopathy coupled with suspicious breast finding requires standard work-up, including biopsy when appropriate; (9) in patients with breast cancer history, interpret and manage post-vaccination lymphadenopathy considering the timeframe from vaccination and overall nodal metastatic risk; (10) complex or unclear cases should be managed by the multidisciplinary team.
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Affiliation(s)
- Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Wien, Austria
| | | | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Wien, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich (TUM) , München , Germany
| | - Gábor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Wien, Austria
| | | | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological, and Pathological Sciences , Università degli Studi di Roma "La Sapienza" , Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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Shraga S, Grinshpun A, Kadouri L, Zick A, Maimon O, Sella T, Adler-Levy Y, Zeltzer G, Granit A, Maly B, Carmon E, Meiner V, Hamburger T, Peretz T. Breast screening in BRCA1/2 carriers leads to earlier detection and superior therapy of breast cancers. Breast 2021. [DOI: 10.1016/s0960-9776(21)00130-2] [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: 10/21/2022] Open
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Slonimsky E, Azraq Y, Gomori JM, Fisch S, Kleinman TA, Sella T. Intravenous Line Phase-Wrap Artifact at Bilateral Axial 3-T Breast MRI: Identification, Analysis, and Solution. Radiol Imaging Cancer 2020; 2:e200004. [PMID: 33778747 DOI: 10.1148/rycan.2020200004] [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] [Received: 01/27/2020] [Revised: 05/06/2020] [Accepted: 06/16/2020] [Indexed: 11/11/2022]
Abstract
Purpose To understand and remove the source of a phase-wrap artifact produced by residual contrast agent in the intravenous line during acquisition of bilateral axial 3-T dynamic contrast material-enhanced (DCE) breast MRI. Materials and Methods A two-part study involved a phantom experiment, followed by an institutional review board approved clinical intervention, to evaluate the phase-wrap artifact at MRI. A phantom model evaluated artifact production by using an intravenous line filled with fluids with varying concentrations of gadolinium-based contrast agent (0, 0.4, 0.8, 1.2, 1.6, and 2 mmol/mL) and by positioning the simulated intravenous line within several fields of view (FOV) at 3-T MRI in breast coils. Next, a clinical assessment was performed with a total of 400 patients (control group:interventional group, 200:200) to determine the effect of taping the intravenous line to the patients' backs. Breast MR images were assessed blindly for the presence of the artifact. Software was used for statistical analysis with a P value of less than .05 considered a significant difference. Results In the phantom model, the artifact was produced only with a 0.4 mmol/mL gadolinium concentration and when the tubing was either close to the edge or within a FOV of 350-450 mm. In the clinical experiment, the artifact was more prevalent in the retrospective control group than in the prospective intervention group (52.5% [105 of 200] vs 22% [44 of 200]; P < .005). Conclusion The presence of phase-wrap artifacts can be reduced by moving the contrast agent intravenous line out of the FOV during acquisition by taping it to a patient's back during bilateral axial 3-T DCE breast MRI.Keywords: Breast, MR-Imaging, Phantom Studies© RSNA, 2020.
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Affiliation(s)
- Einat Slonimsky
- Department of Diagnostic Imaging, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Penn State University Hospital, 500 University Dr, Hershey, PA 17033-0850 (E.S.); Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Affiliated with the Hebrew University Medical School, Jerusalem, Israel (Y.A., J.M.G., S.F., T.S.); and Department of Diagnostic Imaging, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (T.A.K.)
| | - Yusef Azraq
- Department of Diagnostic Imaging, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Penn State University Hospital, 500 University Dr, Hershey, PA 17033-0850 (E.S.); Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Affiliated with the Hebrew University Medical School, Jerusalem, Israel (Y.A., J.M.G., S.F., T.S.); and Department of Diagnostic Imaging, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (T.A.K.)
| | - John M Gomori
- Department of Diagnostic Imaging, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Penn State University Hospital, 500 University Dr, Hershey, PA 17033-0850 (E.S.); Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Affiliated with the Hebrew University Medical School, Jerusalem, Israel (Y.A., J.M.G., S.F., T.S.); and Department of Diagnostic Imaging, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (T.A.K.)
| | - Susan Fisch
- Department of Diagnostic Imaging, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Penn State University Hospital, 500 University Dr, Hershey, PA 17033-0850 (E.S.); Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Affiliated with the Hebrew University Medical School, Jerusalem, Israel (Y.A., J.M.G., S.F., T.S.); and Department of Diagnostic Imaging, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (T.A.K.)
| | - Tal Arazi Kleinman
- Department of Diagnostic Imaging, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Penn State University Hospital, 500 University Dr, Hershey, PA 17033-0850 (E.S.); Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Affiliated with the Hebrew University Medical School, Jerusalem, Israel (Y.A., J.M.G., S.F., T.S.); and Department of Diagnostic Imaging, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (T.A.K.)
| | - Tamar Sella
- Department of Diagnostic Imaging, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Penn State University Hospital, 500 University Dr, Hershey, PA 17033-0850 (E.S.); Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel, Affiliated with the Hebrew University Medical School, Jerusalem, Israel (Y.A., J.M.G., S.F., T.S.); and Department of Diagnostic Imaging, Edith Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (T.A.K.)
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9
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Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, Borbély K, Brkljacic B, Carbonaro LA, Clauser P, Cassano E, Colin C, Esen G, Evans A, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Herranz M, Kinkel K, Kilburn-Toppin F, Kuhl CK, Lesaru M, Lobbes MBI, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Schiaffino S, Sella T, Thomassin-Naggara I, Tardivon A, Ongeval CV, Wallis MG, Zackrisson S, Forrai G, Herrero JC, Sardanelli F. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11:12. [PMID: 32025985 PMCID: PMC7002629 DOI: 10.1186/s13244-019-0803-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 08/27/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.
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Affiliation(s)
- Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Enrico Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Gul Esen
- School of Medicine, Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Eva M Fallenberg
- Diagnostic and Interventional Breast Imaging, Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Michel Herranz
- CyclotronUnit, GALARIA-SERGAS, Nuclear Medicine Department and Molecular ImagingGroup, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224 Chêne-Bougeries, Genève, Switzerland
| | - Fleur Kilburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unit of Radiodiagnostics ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie, Paris, France
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | | | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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10
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Granit RZ, Masury H, Condiotti R, Fixler Y, Gabai Y, Glikman T, Dalin S, Winter E, Nevo Y, Carmon E, Sella T, Sonnenblick A, Peretz T, Lehmann U, Paz K, Piccioni F, Regev A, Root DE, Ben-Porath I. Regulation of Cellular Heterogeneity and Rates of Symmetric and Asymmetric Divisions in Triple-Negative Breast Cancer. Cell Rep 2019; 24:3237-3250. [PMID: 30232005 DOI: 10.1016/j.celrep.2018.08.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 03/28/2018] [Revised: 07/06/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023] Open
Abstract
Differentiation events contribute to phenotypic cellular heterogeneity within tumors and influence disease progression and response to therapy. Here, we dissect mechanisms controlling intratumoral heterogeneity within triple-negative basal-like breast cancers. Tumor cells expressing the cytokeratin K14 possess a differentiation state that is associated with that of normal luminal progenitors, and K14-negative cells are in a state closer to that of mature luminal cells. We show that cells can transition between these states through asymmetric divisions, which produce one K14+ and one K14- daughter cell, and that these asymmetric divisions contribute to the generation of cellular heterogeneity. We identified several regulators that control the proportion of K14+ cells in the population. EZH2 and Notch increase the numbers of K14+ cells and their rates of symmetric divisions, and FOXA1 has an opposing effect. Our findings demonstrate that asymmetric divisions generate differentiation transitions and heterogeneity, and identify pathways that control breast cancer cellular composition.
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Affiliation(s)
- Roy Z Granit
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Hadas Masury
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Reba Condiotti
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Yaakov Fixler
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Yael Gabai
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Tzofia Glikman
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Simona Dalin
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Eitan Winter
- Info-CORE, Bioinformatics Unit of the I-CORE Computation Center at The Hebrew University and Hadassah, Jerusalem 91120, Israel
| | - Yuval Nevo
- Info-CORE, Bioinformatics Unit of the I-CORE Computation Center at The Hebrew University and Hadassah, Jerusalem 91120, Israel
| | - Einat Carmon
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Tamar Sella
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Amir Sonnenblick
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Ulrich Lehmann
- Institute of Pathology, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Keren Paz
- Champions Oncology, Inc., Baltimore, MD 21205, USA
| | | | - Aviv Regev
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Howard Hughes Medical Institute and David H. Koch Institute of Integrative Cancer Biology, Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - David E Root
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ittai Ben-Porath
- Department of Developmental Biology and Cancer Research, Institute for Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel.
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11
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Portal D, Hofstetter L, Eshed I, Dan-Lantsman C, Sella T, Urban D, Onn A, Bar J, Segal G. L3 skeletal muscle index (L3SMI) is a surrogate marker of sarcopenia and frailty in non-small cell lung cancer patients. Cancer Manag Res 2019; 11:2579-2588. [PMID: 31114324 PMCID: PMC6497853 DOI: 10.2147/cmar.s195869] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 11/24/2018] [Accepted: 02/23/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Non-small cell lung cancer (NSCLC) is a common and highly lethal disease. As advanced treatment modalities are being developed, improved prognostication methods are sought. L3 skeletal muscle index (L3SMI) and alanine aminotransferase (ALT) levels are accepted surrogate markers of sarcopenia and related frailty. We aimed to evaluate the potential association of these markers with NSCLC patients’ survival. Methods: A retrospective, single-center study of an NSCLC patients’ cohort. L3SMI was calculated based on skeletal muscle area on computed tomography scans at the level of the L3 vertebra. Clinical data were extracted from clinical charts. Results: A total of 140 patients (56.4% males, median age 66 [range 37–86]) were included in this study, 32% were diagnosed at stage 3 and 45% at stage 4. During the follow-up duration (median of 1.9 years; range 1 month to 6.4 years), 102 patients (72.8%) died. Patients’ characteristics that were found to be associated with increased mortality were performance status, albumin and tumor stage at diagnosis. Sarcopenia, defined as low L3SMI (lower than 41 cm2/m2 for women and lower than 53 cm2/m2 for men) was significantly associated with higher risk of mortality compared with patients with normal L3SMI values (77.2%, vs 64.6%, p=0.013) in univariate analysis, but not in a multiple regression analysis. Conclusion: Low L3SMI could serve as a surrogate marker for sarcopenia and frailty and, as such, facilitate the prognostication process of NSCLC patients.
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Affiliation(s)
- D Portal
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - L Hofstetter
- Department of Internal Medicine 'T', Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - I Eshed
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Dan-Lantsman
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - T Sella
- The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel.,Institute of Oncology, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - D Urban
- Institute of Oncology, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - A Onn
- Institute of Oncology, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Institute of Pulmonary Medicine, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - J Bar
- Institute of Oncology, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - G Segal
- Department of Internal Medicine 'T', Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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12
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Sklair-Levy M, Segev A, Sella T, Calderon-Margalit R, Zippel D. Mammographic breast density in recent and longer-standing ethiopian immigrants to israel. Breast J 2018; 24:772-777. [PMID: 29687576 DOI: 10.1111/tbj.13042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/14/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
Abstract
High breast density is associated with an increased risk of breast cancer development. Little is known concerning ethnic variations in breast density and its relevant contributing factors. We aimed to study breast density among Ethiopian immigrants to Israel in comparison with Israeli-born women and to determine any effect on breast density of the length of residency in the immigrant population. Mammographic breast density using the BI-RADS system was estimated and compared between 77 women of Ethiopian origin who live in Israel and 177 Israeli-born controls. Logistic regression analysis was performed to estimate the odds ratios (OR) for high density (BI-RADS score ≥ 3) vs low density (BI-RADS score < 3) cases, comparing the 2 origin groups. Ethiopian-born women had a crude OR of 0.15 (95% CI: 0.08-0.26) for high breast density compared with Israeli-born women. Adjustments for various cofounders did not affect the results. Time since immigration to Israel seemed to modify the relationship, with a stronger association for women who immigrated within 2 years prior to mammography (OR:0.07, 95% CI: 0.03-0.17) as opposed to women with a longer residency stay in Israel (OR:0.23, 95% CI:0.10-0.50). Adjustments of various confounders did not alter these findings. Breast density in Ethiopian immigrants to Israel is significantly lower than that of Israeli-born controls. Our study suggests a positive association between time since immigration and breast density. Future studies are required to define the possible effects of dietary change on mammographic density following immigration.
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Affiliation(s)
- Miri Sklair-Levy
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev
- Department of Radiology-Medical Imaging, Hadassah Medical Center, Jerusalem, Israel
| | - Tamar Sella
- Department of Radiology-Medical Imaging, Hadassah Medical Center, Jerusalem, Israel
| | | | - Douglas Zippel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
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13
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Sella T, Ackerstein A, Halperin S, Hout-Siloni G, Lieberman S, Barshack I, Nechushatan H, Berger R, Bar J, Onn A. P3.03-028 WINTHER – a Study of Cancer Therapy Based on Tumor and Normal-Matched Biopsies – the Sheba Medical Center Lung Cancer Experience. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1655] [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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14
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Sella A, Kovel S, Sella T. PSA kinetics impact on CT-PET PSMA uptake in prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.036] [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: 11/13/2022] Open
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15
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Sella T, Laufer N. Introduction: Imaging in reproduction. Fertil Steril 2016; 105:1379-80. [PMID: 27117374 DOI: 10.1016/j.fertnstert.2016.04.026] [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] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
The authors of this Views and Reviews outline in detail the indispensable role of imaging tools-ultrasound, computed tomography, and magnetic resonance imaging-in the diagnosis and treatment of female and male factor infertility. Equipment producing diagnostic images, coupled with ever-increasing computing power, will pave the way for novel functional dynamic studies that will expand the understanding of reproductive processes and their management.
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Affiliation(s)
- Tamar Sella
- Marlene Greenebaum Diagnostic Breast Center, Jerusalem, Israel
| | - Neri Laufer
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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16
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Sonnenblick A, Eleyan F, Peretz T, Ospovat I, Merimsky O, Sella T, Peylan-Ramu N, Katz D. Gemcitabine in combination with paclitaxel for advanced soft-tissue sarcomas. Mol Clin Oncol 2015; 3:829-832. [PMID: 26171190 DOI: 10.3892/mco.2015.545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/31/2014] [Accepted: 02/20/2015] [Indexed: 11/06/2022] Open
Abstract
A limited number of chemotherapeutic agents have been found to be active against advanced soft-tissue sarcomas (STSs), particularly sarcomas that have progressed following doxorubicin treatment. The aim of this retrospective study was to determine the response to treatment with gemcitabine plus paclitaxel in patients with STSs. Data were collected on all patients with advanced non-resectable STS who were treated with a fixed dose 700 mg/m2 gemcitabine in combination with 70 mg/m2 paclitaxel on days 1 and 8 every 3 weeks. A total of 30 patients were included, with a median age of 56.4 years (range, 40-70 years). The gemcitabine/paclitaxel combination was well tolerated, with an overall response in 27% and a clinical benefit in 57% of the patients. The median progression-free survival was 6.1 months and the overall survival was 14.3 months. In conclusion, gemcitabine plus paclitaxel was found to be tolerable and effective in patients with advanced STSs.
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Affiliation(s)
- Amir Sonnenblick
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Feras Eleyan
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Inna Ospovat
- Department of Oncology, The Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel
| | - Ofer Merimsky
- Department of Oncology, The Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel
| | - Tamar Sella
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Nili Peylan-Ramu
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Daniela Katz
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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17
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Sella T, Goren I, Shalev V, Shapira H, Zandbank J, Rosenblum J, Kimlin M, Chodick G. Incidence trends of keratinocytic skin cancers and melanoma in Israel 2006-11. Br J Dermatol 2014; 172:202-7. [DOI: 10.1111/bjd.13213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- T. Sella
- Medical Division; Maccabi Healthcare Services; Tel Aviv Israel
- Department of Oncology; Sheba Medical Center; Tel Hashomer Israel
| | - I. Goren
- Medical Division; Maccabi Healthcare Services; Tel Aviv Israel
| | - V. Shalev
- Medical Division; Maccabi Healthcare Services; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - H. Shapira
- Pathology Laboratory; Maccabi Healthcare Services; Tel Aviv Israel
| | - J. Zandbank
- Pathology Laboratory; Maccabi Healthcare Services; Tel Aviv Israel
| | - J. Rosenblum
- Medical Division; Maccabi Healthcare Services; Tel Aviv Israel
| | - M.G. Kimlin
- AusSun Research Laboratory; Institute of Health and Biomedical Innovation,Queensland University of Technology; Brisbane Qld Australia
| | - G. Chodick
- Medical Division; Maccabi Healthcare Services; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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18
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Sella A, Sella T, Kovel S. The Effect of Neutrophil to Lymphocyte Ratio (NLR) Prior to Taxotere-Based Chemotherapy in Patients (PT'S) with Metastatic Castration Resistant Prostate Cancer (MCRPC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33511-0] [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] Open
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19
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Abstract
Improved accuracy in oncological computed tomography (CT) could lead to a decrease in morbidity and improved survival for oncology patients. Visualization of metabolic activity using the glucose analogue [18F]fluorodeoxyglucose (FDG) in combination with the high anatomic resolution of CT in an integrated positron emission tomography (PET)/CT examination has the highest sensitivity and specificity for the detection of primary and metastatic lesions. However, PET/CT costs are high and patient access is limited; thus CT remains the primary imaging modality in oncology patients. We have noted that subtle lesions are more easily detected on CT by radiologists with PET/CT experience. We aimed to provide a brief review of the literature with comparisons of multi-detector computed tomography (MDCT) and PET/CT in primary and metastatic disease with an emphasis on findings that may be overlooked on MDCT in cancer of the breast, lung, colon, and ovaries, and in melanoma, as well as thrombosis in oncology patients. We further reviewed our experience for illustrative comparisons of PET/CT and MDCT studies. Experience in interpreting conventional CT scans alongside PET/CT can help the reader develop an appreciation for the subtle appearance of some lesions on CT that might otherwise be missed. This could improve detection rates, reduce errors, and improve patient management.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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20
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Sella T, Chodick G, Lunenfeld E, Shalev V. Further evidence on the high prevalence of male factor infertility diagnosis in Israel. Isr Med Assoc J 2011; 13:386. [PMID: 21809743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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21
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Sella T, Chodick G, Barchana M, Heymann AD, Porath A, Kokia E, Shalev V. Gestational diabetes and risk of incident primary cancer: A large population-based cohort study in Israel. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1538] [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: 11/20/2022] Open
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22
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Sella T, Shoshan A, Goren I, Shalev V, Blumenfeld O, Laron Z, Chodick G. A retrospective study of the incidence of diagnosed Type 1 diabetes among children and adolescents in a large health organization in Israel, 2000-2008. Diabet Med 2011; 28:48-53. [PMID: 21166845 DOI: 10.1111/j.1464-5491.2010.03174.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS To determine the incidence and examine temporal trends of Type 1 diabetes among children aged < 18 years, in a large Israeli health organization. METHODS All incident Type 1 diabetes cases diagnosed between 2000 and 2008 were ascertained from an automated diabetes registry based on members' electronic records and validated by comparison with the Israel Juvenile Diabetes Register. RESULTS During the study period, a total of 648 incident cases of Type 1 diabetes were identified. The average annual age-and-sex-standardized incidence was 11.09 per 100,000 person-years. There was an annual 5.82% (95% CI 1.80-9.98%) rise in incidence, with a greater relative increase in toddlers under 5 years of age. Incidence increased with age and demonstrated seasonal variation. Mean age at onset of diabetes significantly (P = 0.07) decreased from 10.21 years (SD = 4.48) in 2000-2002 to 9.25 years (SD = 4.54) in 2006-2008. Among very young patients (< 5 years), average blood glucose values at diagnosis dropped from 32.4 mmol/l (SD = 9.5) to 19.5 mmol/l (SD = 11.0) over the study period, with little change in average glucose for older children. CONCLUSIONS Incidence of diagnosed Type 1 diabetes continues to increase in Israel at a rate that is high compared with similar American and European populations. At the same time, the clinical presentation of children is changing.
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Affiliation(s)
- T Sella
- Medical Division, Maccabi Healthcare Services Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Abstract
AIMS To determine the incidence of postpartum diabetes mellitus in the years following a diagnosis of gestational diabetes mellitus (GDM) and to determine whether the severity of GDM, represented by the magnitude of the deviation of diagnostic tests from the normal values or requirement for medications, is associated with the development of diabetes. METHODS A retrospective cohort study was performed among 185 416 pregnant women who had glucose challenge test or 3 h oral glucose tolerance test (OGTT) in a large health maintenance organization in Israel. Subsequent diagnosis of diabetes was ascertained by using an automated patient registry. RESULTS A total of 11 270 subjects were diagnosed with GDM, comprising 6.07% of the cohort. During a total follow-up period of 1 049 334 person-years there were 1067 (16.9 per 1000 person-years) and 1125 (1.1 per 1000 person-years) diagnoses of postpartum diabetes among GDM and non-GDM women, respectively. The cumulative risk of incident diabetes in GDM patients with up to 10 years of follow-up was 15.7%, compared with 1% among the non-GDM population. Gestational diabetes mellitus was associated with nearly an eightfold higher risk of postpartum diabetes after adjusting for important confounders, such as socioeconomic status and body mass index. Among women with a history of GDM, the number of abnormal OGTT values and use of insulin were associated with a substantially higher risk for developing diabetes. CONCLUSIONS Three or four abnormal OGTT values and GDM requiring insulin or oral hypoglycaemic medications are important predictors of postpartum diabetes risk in women with a history of GDM.
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Affiliation(s)
- G Chodick
- Medical Division, Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, Israel.
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24
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Eliahou R, Sella T, Allweis T, Samet Y, Libson E, Sklair-Levy M. Magnetic resonance-guided interventional procedures of the breast: initial experience. Isr Med Assoc J 2009; 11:275-279. [PMID: 19637504] [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: 05/28/2023]
Abstract
BACKGROUND Magnetic resonance imaging of the breast has emerged as a valuable imaging tool in addition to conventional imaging modalities. It has high sensitivity for malignant lesions and can detect mammographically, sonographically and clinically occult cancers. "MR only" lesions are best biopsied under MR guidance; however, this may be a challenging task. OBJECTIVES To evaluate our initial clinical experience with MR-guided core needle breast biopsy and MR-guided needle localization. METHODS We retrospectively evaluated 81 women with 97 lesions, who were scheduled for guided core needle biopsy or MR-guided needle localization followed by surgery. Lesions were categorized as malignant, high risk, or benign according to the BI-RADS MR classification system. MR findings were compared with final histopathology or with follow-up imaging findings. RESULTS Fifteen (16%) lesions were malignant (9 invasive ductal carcinoma, 2 invasive lobular carcinoma, 4 ductal carcinoma in situ); 7 (7%) lesions were high risk (4 atypical ductal hyperplasia, 3 radial scars); 75 (77%) lesions were benign, mainly fibrocystic changes. Other benign findings were sclerosing adenosis, pseudoangiomatous stromal hyperplasia, fat necrosis, intraductal papilloma, fibroadenoma, capillary hemangioma, and florid ductal hyperplasia. No major complications were encountered. CONCLUSIONS MR-guided interventional procedures of the breast are accurate, safe and feasible methods for sampling breast lesions detected only by MR and have become a significant tool in the management of certain patients.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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25
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Lieberman S, Sella T, Maly B, Sosna J, Uziely B, Sklair-Levy M. Breast magnetic resonance imaging characteristics in women with occult primary breast carcinoma. Isr Med Assoc J 2008; 10:448-452. [PMID: 18669145] [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: 05/26/2023]
Abstract
BACKGROUND Occult breast cancer without clinically or mammographically detectable breast tumor is an uncommon presentation. OBJECTIVES To assess the role of breast MRI in women with metastatic carcinoma and an occult primary, and to define the MRI characteristics of the primary breast tumor. METHODS This retrospective study evaluated 20 women with metastatic carcinoma of unknown origin who underwent breast MRI between 2000 and 2006. Four women were excluded, leaving 16 in the study group. Probability of malignancy was assessed according to BIRADS classification. MRI performance in detecting lesions and evaluating disease extent was assessed, with the gold standard being surgical or biopsy pathology. RESULTS MRI detected suspicious lesions in 15 patients. Lesion size ranged from 0.4 to 7 cm (median 1.5 cm). MRI detected a single lesion in 6 patients (40%), multifocal disease in 3 (20%), multicentric disease in 4 (27%), and bilateral breast lesions in 2 (13%). In 13 patients MRI depicted the primary breast cancer. Initial treatment was surgical in 9; MRI correctly estimated disease extent in 6 (67%), underestimated disease extent in 1 (11%), and overestimated it in 2 (22%). Four patients had biopsy followed by chemotherapy; one had multicentric disease and one had multifocal disease. MR findings were false positive in two patients and false negative in one. CONCLUSIONS MRI is sensitive in detecting the primary tumor and beneficial in assessing tumor extent. Small size and multiple foci are common features. We suggest that bilateral breast MRI be part of the evaluation of women with metastatic carcinoma and an occult primary.
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Affiliation(s)
- Sivan Lieberman
- Department of Diagnostic Radiology, Hadassah-Hebrew University Medical Center (Ein Kerem Campus), Jerusalem, Israel.
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26
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Tsirigotis P, Sella T, Shapira MY, Bitan M, Bloom A, Kiselgoff D, Levin M, Libster D, Abdul Hai A, Gesundheit B, Or R, Slavin S, Resnick I. Peliosis hepatis following treatment with androgen-steroids in patients with bone marrow failure syndromes. Haematologica 2007; 92:e106-10. [PMID: 18024386 DOI: 10.3324/haematol.11343] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Androgens widely used in the treatment of bone marrow failure syndromes can in rare cases cause hepatic peliosis, a pathological entity characterized by multiple blood-filled cavities in the liver parenchyma. Bone marrow failure syndromes per se are associated with a low coagulation status, which is further magnified by bone marrow transplantation for aplastic anaemia due to deep thrombocytopenia. Both these conditions can cause bleeding; their combination is especially dangerous. We describe two cases of aplastic anaemia due to paroxysmal nocturnal hemoglobinuria and Fanconi syndrome, in which patients developed peliosis hepatis after prolonged treatment with androgens. One patient developed severe subcapsular bleeding, successfully treated with catheterization of the right hepatic artery and embolization of the bleeding site. The second patient bridged over deep post-transplant aplasia with high frequency platelet transfusions, and demonstrated an uncomplicated post-BMT course. We suggest avoiding or interrupting treatment with androgens in patients preparing for BMT.
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Affiliation(s)
- P Tsirigotis
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah University Hospital, Jerusalem, Israel
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27
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Abstract
OBJECTIVE Adnexal torsion is most commonly a clinical diagnosis, often aided by sonographic findings. At times, the clinical presentation can mimic nongynecologic causes of acute lower abdominal pain. In these cases, CT may be the initial imaging study. The purpose of this study was to define the CT features associated with adnexal torsion. CONCLUSION On CT, a well-defined adnexal mass abnormally located in the pelvis with ipsilateral deviation of the uterus in a woman or girl with lower abdominal pain should raise the suspicion of adnexal torsion. Inflammatory signs on CT suggest the presence of necrosis.
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Affiliation(s)
- Nurith Hiller
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12227, Jerusalem, Israel, 91121
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28
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Portnoy O, Apter S, Koukoui O, Konen E, Amitai MM, Sella T, Gayer G, Hertz M. Gas in the kidney: CT findings. Emerg Radiol 2007; 14:83-7. [PMID: 17431695 DOI: 10.1007/s10140-007-0599-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
Gas in the renal parenchyma is a rare finding seen best with computed tomography (CT). It can be encountered in a wide range of clinical conditions, some of them life-threatening like emphysematous pyelonephritis, whereas in others, it may represent a postoperative or procedure outcome. The latter are not usually a clinical emergency (for example, after nephrostomy insertion or in a urinary intestinal connection). Due to the increasing use of abdominal CT examinations, radiologists, especially in emergency setting, should be aware of this rare finding and be familiar with its differential diagnosis.
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Affiliation(s)
- Orith Portnoy
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Ramat Gan, 52621, Israel.
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29
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Lieberman S, Libson E, Sella T, Lebensart P, Sosna J. Percutaneous Image-Guided Splenic Procedures: Update on Indications, Technique, Complications, and Outcomes. Semin Ultrasound CT MR 2007; 28:57-63. [PMID: 17366709 DOI: 10.1053/j.sult.2006.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous image-guided splenic procedures are seldom performed due to fear of complications, mainly hemorrhage. Percutaneous splenic invasive procedures are, however, safe, and in most cases, the complication rates are similar to those of other abdominal organs. In most patients, biopsy of a focal splenic lesion establishes the diagnosis. Aspiration and drainage of splenic collections are performed obviating the need for splenectomy. In this review we describe the indications, technique, complications, and outcomes of percutaneous splenic biopsy, aspiration, and drainage.
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Affiliation(s)
- Sivan Lieberman
- Department of Radiology, Hadassah-Hebrew University Hospital, P.O.B. 12000, Jerusalem, Israel 91120.
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30
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Shavit L, Sella T, Grenader T. Malignant esophagopleural fistula. Isr Med Assoc J 2007; 9:125. [PMID: 17348490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Linda Shavit
- Department of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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31
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Abstract
CT colonography (CTC) and conventional colonoscopy may have similar efficacy for detection of polyps > 6 mm. Perforation of the colon and rectum is a relatively rare, but potentially morbid complication of CTC, especially in symptomatic patients. Older age and underlying concomitant colon pathology increase the risk of perforation. This review describes the incidence, clinical features, and management of colon perforations at CTC, a study that was considered risk-free until recently.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
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32
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Sella T, Schwartz LH, Hricak H. Retained Seminal Vesicles After Radical Prostatectomy: Frequency, MRI Characteristics, and Clinical Relevance. AJR Am J Roentgenol 2006; 186:539-46. [PMID: 16423965 DOI: 10.2214/ajr.04.1770] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Changes after radical prostatectomy (RP) may present potential pitfalls in the interpretation of pelvic MRI studies in post-RP patients. One such change is retained seminal vesicles (SVs). The purpose of this study was to characterize the MRI features and evaluate the frequency of retained SV remnants in patients after RP. CONCLUSION Retained SV remnants are a common finding after RP. Most are fibrotic distal tips. Recognition of SV remnants may prevent their misinterpretation as local recurrences.
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Affiliation(s)
- Tamar Sella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Room C-278, New York, NY 10021, USA
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33
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Grenader T, Gutfeld O, Shavit L, Sella T, Peretz T. [Metastatic testicular cancer presenting with venous thromboembolism]. Harefuah 2006; 145:30-1, 78. [PMID: 16450721] [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: 05/06/2023]
Abstract
Metastatic testicular cancer can be associated with a variety of complications due to obstruction or invasion of adjacent structures. This is a case study of 2 patients with testicular cancer who presented with venous thromboembolism.
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Affiliation(s)
- Tal Grenader
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center.
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Galinsky D, Kisselgoff D, Sella T, Peretz T, Libson E, Sklair-Levy M. Effect of breast magnetic resonance imaging on the clinical management of breast cancer. Isr Med Assoc J 2005; 7:700-3. [PMID: 16308991] [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: 05/05/2023]
Abstract
BACKGROUND Mammography is the principal breast cancer imaging technique; however, sensitivity is reduced, especially in dense breast tissue. Magnetic resonance imaging is increasingly used in the detection and characterization of breast cancers. The high sensitivity (95-100%) of MRI is consistently observed, and in many situations, MRI is proving superior to classical forms of imaging. Assessment of its impact on management and outcome is vital if MRI is to become standard in the management of breast cancers. OBJECTIVES To establish the impact of breast MRI on women undergoing testing in our institution. METHODS We analyzed 82 cases that underwent MRI between January 2001 and April 2003. Analysis appraised the clinical impact of MRI testing in cases where medical summaries were available. RESULTS Studies were categorized into five indications: a) screening in high risk women (n=7), b) search for primary disease in the presence of disease (n=5), c) monitoring of chemotherapy (n=2), d) postoperative assessment of tumor bed (n=9), and e) diagnostic/characterization of primary or recurrent breast cancer (n=59). Results were defined as negative, positive, or no impact on clinical management. MRI testing had a positive impact in 62 cases, affecting measurable change in 9 cases. Benefit was seen in screening, diagnosis and postoperative cases. In 15 cases, MRI stimulated investigations. CONCLUSION MRI is a valuable tool in breast imaging and affects management. Further trials are necessary to clearly define the role of MRI and to ascertain whether in cases where beneficial impact on management is noted, there is ultimate impact on outcome.
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Affiliation(s)
- Daliah Galinsky
- Department of Oncology, Sharett Institute, Hadassah Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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Sosna J, Sella T, Shaham D, Shapira SC, Rivkind A, Bloom AI, Libson E. Facing the new threats of terrorism: radiologists' perspectives based on experience in Israel. Radiology 2005; 237:28-36. [PMID: 16100082 DOI: 10.1148/radiol.2371040585] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
On September 11, 2001, the world changed. The vicious giant of terrorism that was dormant until that date had arisen. After the horrific mass-casualty terror attack on the United States, any and all forms of assault seem possible. Owing to the complexity of injuries encountered in terror attack victims, fast and accurate imaging plays an essential role in triage and identification of abnormalities associated with injuries. The radiologist becomes a crucial part of the first-line team of doctors treating these patients. Knowledge that the best available treatment is given to terror attack victims can enhance the strength and endurance of society against terror. On the basis of the authors' experience with terror events in Israel, the steps involved in imaging of terror attack patients include conventional radiography, focused abdominal sonography in trauma, computed tomography, and angiography, with the judicious use of supplemental imaging.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah University Hospital, Hebrew University Medical School, POB 12000, Jerusalem, Israel IL-91120.
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36
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Abstract
This review focuses on the detection of extracolonic findings at CT colonography (CTC). Since its introduction, it has been regarded as a promising alternative to conventional colonoscopy for the detection of colorectal polyps and cancers. Unlike conventional colonoscopy and barium enema, CTC allows evaluation not only of the colon but also visualization of the lung bases, the abdomen, and the pelvis. CTC is performed with thin sections (1-5 mm) and small intervals (0.5-2 mm), enabling superb image reconstruction. The ability to evaluate the extracolonic structures can present a clinical dilemma. On the one hand, CTC may incidentally demonstrate asymptomatic malignant diseases or other clinically important conditions, thus possibly reducing morbidity or mortality. On the other hand, CTC may reveal numerous findings of no clinical relevance; this could result in costly additional diagnostic examinations with an increase in morbidity and overall negative impact on patients' health. In this article, extracolonic findings at CTC will be reviewed and the potential benefits and disadvantages will be presented.
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Affiliation(s)
- J Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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37
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Abstract
OBJECTIVE Lateral ovarian transposition is a surgical procedure performed in premenopausal women with pelvic malignancies in which the ovaries are surgically displaced from the pelvis, before radiation therapy. In this article, we present the imaging features of normal transposed ovaries as well as the spectrum of abnormalities associated with lateral ovarian transposition. CONCLUSION After lateral ovarian transposition, it is important to recognize the ovaries to avoid confusing them with peritoneal implants. In addition, benign ovarian lesions must be distinguished from primary and secondary malignancies.
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Affiliation(s)
- Tamar Sella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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38
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Hiller N, Sella T, Lev-Sagi A, Fields S, Lieberman S. Computed tomographic features of tuboovarian abscess. J Reprod Med 2005; 50:203-8. [PMID: 15841934] [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: 05/02/2023]
Abstract
OBJECTIVE To describe the spectrum and frequency of computed tomographic (CT) features in tuboovarian abscess (TOA) in order to increase the utility of computed tomography in diagnosing this condition. STUDY DESIGN Search of our hospital registry found 22 patients diagnosed with TOA who underwent pelvic tomography between the years 1998 and 2001. A retrospective review of their CT scans was performed, and the CT features of TOA were recorded. Clinical signs and symptoms were also summarized. RESULTS All 22 patients presented with lower abdominal pain. Additional clinical signs of TOA, such as a palpable abdominal mass (23%), vaginal discharge (27%) and fever (36%), were less common. On tomography the majority of TOAs were unilateral (73%) and multilocular (89%) and had fluid density (95%) and a thick, uniform, enhancing wall (95%). Other common CT findings were thickening of the mesosalpinx (91%) and infiltration into pelvic fat (91%). Less common CT findings included bowel thickening (59%), thickening of the uterosacral ligaments (64%) and pyosalpinx (50%). Ascites, lymphadenopathy, peritoneal involvement and hydronephrosis were uncommon findings on tomography. CONCLUSION Computed tomography is a useful imaging modality in the diagnosis of TOA, especially in cases that are clinically indeterminate. Recognition of the spectrum of CT findings and their frequency can result in improved CT diagnosis of this disease.
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Affiliation(s)
- Nurith Hiller
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel.
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39
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Sella T, Schwartz LH, Swindle PW, Onyebuchi CN, Scardino PT, Scher HI, Hricak H. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 2004; 231:379-85. [PMID: 15064390 DOI: 10.1148/radiol.2312030011] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.7] [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] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate endorectal coil magnetic resonance (MR) imaging in the depiction of local recurrence after radical prostatectomy. MATERIALS AND METHODS Endorectal MR images were reviewed retrospectively in 82 patients who underwent prostatectomy. The interval between prostatectomy and MR imaging ranged between 0.5 and 13.0 years (mean, 3.25 years). Local recurrence was considered present if there was no evidence of distant metastases and there was a positive biopsy result, subsequent reduction in prostate-specific antigen (PSA) level after radiation therapy of the pelvis, or serial MR imaging findings of increased tumor size. Local recurrence on MR images was assessed for location, size, signal intensity, and invasion of adjacent structures. All images were reviewed independently by two readers who were blinded to clinical information. RESULTS Thirty-four of 82 patients did not meet inclusion criteria. Forty-one of 48 remaining patients had clinically documented local recurrence, which MR imaging depicted in 39 of 41 (95%) patients. Seven of 48 patients had no evidence of local or distant metastases, and none had positive MR imaging findings. Sensitivity of MR imaging was 95%, and specificity was 100%. Local recurrences were perianastomotic in 12 (29%) patients and retrovesical in 17 (40%), within retained seminal vesicles in nine (22%), and at anterior or lateral surgical margins in four (9%). All local recurrences were hyperintense to adjacent pelvic muscles on T2-weighted MR images. The mean diameter of tumors was 1.4 cm (range, 0.8-4.5 cm). PSA levels at MR imaging in patients with clinically proved recurrences ranged from undetectable to 10 ng/mL (mean, 2.18 ng/mL). CONCLUSION MR imaging depicts a high proportion of local recurrence after prostatectomy. The authors propose incorporation of endorectal coil MR imaging in the diagnostic paradigm of patients who have undergone prostatectomy and are suspected of having local recurrence.
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Affiliation(s)
- Tamar Sella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
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40
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Shaham D, Sella T, Makori A, Appelbum L, Rivkind AI, Bar-Ziv J. The role of radiology in terror injuries. Isr Med Assoc J 2002; 4:564-7. [PMID: 12120475] [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: 02/25/2023]
Abstract
Although one might think that nothing could be further apart than "terror" and "medicine," in reality, medicine is intimately involved in the rescuing of those who are injured in terrorist attacks and in identifying and determining the cause of death in those who do not survive. Radiology has an important role in the workup of trauma patients in general, and in patients injured during the course of a terrorist attack in particular. Radiologic examinations determine the location and severity of injuries and are used to follow injured patients, particularly when complications occur. Conventional X-rays and CT scans are useful to detect the presence of foreign bodies, such as bullets, shrapnel and nails, which are often combined with the explosive charge in suicide bombings. Both can also be used for postmortem examinations. Although biologic, chemical and radiologic warfare constitute a real threat for the future, it is essential that we be familiar with the more "conventional" forms of terror that we face today.
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Affiliation(s)
- Dorith Shaham
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel.
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41
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Abstract
OBJECTIVE The purpose of our study was to examine the role of chest CT scans in routine follow-up of patients who had been treated for ovarian carcinoma. MATERIALS AND METHODS The radiologic follow-up of 127 women with metatastic ovarian carcinoma who had undergone surgery and chemotherapy between 1985 and 1996 was reviewed. In reviewing each patient's medical record, we determined whether a chest CT scan had been obtained, and if so, how many had been obtained during the patient's follow-up period. For patients with a chest CT scan, an analysis of the presence of disease in the thorax and its relation to disease in the abdomen and pelvis, as revealed on CT images, was performed. RESULTS Of the patients whose cases were examined, 82 (65%) had had at least one chest CT scan obtained, with more than 50% having had three or more scans. Thirty-two (39%) patients had no radiologic evidence of disease. Twenty-eight (34%) showed disease in the abdomen or pelvis but no disease in the chest. Eighteen (22%) had both chest and abdominal or pelvic CT scans that indicated disease. In all of these patients, abdominal or pelvic disease had appeared on scans before spreading to the chest. Four (5%) of the patients had isolated chest disease. The rate of lung metastases from ovarian carcinoma in our series was 6%. In all of these patients, pulmonary metastases were preceded either by abdominal or pelvic disease or by a rise in tumor markers. CONCLUSION Pulmonary metastases in ovarian carcinoma are rare and usually preceded by recurrence of carcinoma in the abdomen or pelvis. We suggest that chest CT scanning could be eliminated in the routine follow-up of patients who have been treated for ovarian carcinoma; yet it should be performed for those patients with elevated serum tumor markers but without evidence of abdominal or pelvic disease.
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Affiliation(s)
- T Sella
- Department of Radiology, Hadassah University Hospital, P. O. Box 12227, Jerusalem, Israel, 91121
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42
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Abstract
BACKGROUND The CT appearance of the normal and abnormal thymus and its age-related changes have been described. However, there is no information regarding the change in thymus CT attenuation values in children. OBJECTIVE The aim of the present study was to evaluate the normal CT attenuation of the thymus in infants and children and discover when the decline begins. MATERIALS AND METHODS CT attenuation values of the thymus were retrospectively evaluated in 152 children between ages of 1 day and up to 14 years. For each patient the mean value of the CT thymus attenuation was calculated and compared to CT attenuation of the chest wall and cardiac muscles. We also examined the correlation between thymic attenuation, gender, and disease. The statistical analysis used was multivariate linear regression. RESULTS CT attenuation of the thymus declines with age, beginning only after the 1st year of life. The thymus is more hyperdense than the chest wall and cardiac muscles in infants less than 1 year. The thymus is denser in males than females. In malignant conditions, in infants less than 1 year, thymus CT attenuation is decreased. In older children thymus attenuation was similar to that for the chest wall and cardiac muscles. CONCLUSION The decline in thymic CT attenuation with age is consistent with fatty infiltration of the gland. The measurements given in this report can serve as a basis for comparison to determine whether the thymus of a young child is normal or pathological.
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Affiliation(s)
- M Sklair-Levy
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
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Gayer G, Apter S, Jonas T, Amitai M, Zissin R, Sella T, Weiss P, Hertz M. Polysplenia syndrome detected in adulthood: report of eight cases and review of the literature. Abdom Imaging 1999; 24:178-84. [PMID: 10024407 DOI: 10.1007/s002619900471] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To present the computed tomographic (CT) features of the abdominal anomalies consistent with polysplenia syndrome in adults. Awareness of these abnormalities may avoid misdiagnosing characteristic findings as separate pathological processes. METHODS Imaging studies, mainly abdominal CT scans, of eight patients were reviewed. Attention was directed to the location of the multiple spleens, stomach, and liver and to the possible presence of a short pancreas, malrotation of the intestine, and venous anomalies. We also reviewed the CT findings of 15 adult patients described in the literature. RESULTS Three men and five women underwent CT for various unrelated conditions. The most common findings were multiple spleens along the greater curvature of the stomach, which were located in the right upper quadrant in six patients. The inferior vena cava was seen on the left side in seven subjects, with azygos/hemiazygos continuation in six. A preduodenal portal vein was present in seven subjects. The liver was in the midline in four patients and on the left side in two. A short pancreas was seen in four patients, intestinal nonrotation in five, and dextrocardia in two. The prevalence of these anomalies was similar to that of the reviewed cases. CONCLUSIONS CT proved to be an excellent imaging modality in the diagnosis of the abdominal anomalies. Some of these (a short pancreas, multiple spleens, and azygos continuation) can simulate pathological processes. Hence the importance of recognizing these CT findings as part of a syndrome.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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