Percutaneous ultrasound-guided cryoablation for early-stage primary breast cancer: a follow-up study in Japan

BACKGROUND

Ultrasound-guided percutaneous cryoablation (PCA) for early-stage breast cancer (ESBC) can be performed under local anesthesia in an outpatient clinic. This study continues a pilot stage to examine local control, safety, patient quality of life (QoL), satisfaction and cosmetic outcomes of cryoablation for ESBC.

METHODS

PCA was performed under local anesthesia for patients with primary ESBC, followed by radiation and endocrine therapies. Oncologic outcomes were examined by imaging (mammography, ultrasound, MRI) at baseline and 1, 6, 12, 24, 36, and 60 months post-cryoablation. EQ-VAS, EQ-5D-5L, subjective satisfaction and Moiré topography were used to measure health-related QoL outcomes.

RESULTS

Eighteen patients, mean aged 59.0 ± 9.0 years, mean tumor size 9.8 ± 2.3 mm, ER + , PR + (17/18), HER2-, Ki67 < 20% (15/18), underwent PCA and were followed for a mean of 44.3 months. No serious adverse events were reported, and no patients had local recurrence or distant metastasis in the 5-year follow-up. Cosmetic outcomes, satisfaction level, and QoL all improved post-cryoablation. Five-year average reduction rates of the cryolesion long, short, and depth diameters, on US, were 61.3%, 42.3%, and 22.8%, respectively, compared to the 86.2% volume reduction rate on MRI. The correlation coefficient between MRI and US measurement criteria was highest for the long diameter. During follow-up, calcification of the treated area was observed in 13/18 cases.

CONCLUSION

Cryoablation for ESBC is an effective and safe procedure with excellent cosmetic outcomes and improved QoL. This study contributes to the growing evidence supporting cryoablation as a potential standard treatment for ESBC, given compliance to pre-defined patient selection criteria.

Inter- and intra-observer variability of qualitative visual breast-composition assessment in mammography among Japanese physicians: a first multi-institutional observer performance study in Japan

BACKGROUND

Visual assessment of mammographic breast composition remains the most common worldwide, although subjective variability limits its reproducibility. This study aimed to investigate the inter- and intra-observer variability in qualitative visual assessment of mammographic breast composition through a multi-institutional observer performance study for the first time in Japan.

METHODS

This study enrolled 10 Japanese physicians from five different institutions. They used the new Japanese breast-composition classification system 4th edition to subjectively evaluate the breast composition in 200 pairs of right and left normal mediolateral oblique mammograms (number determined using precise sample size calculations) twice, with a 1-month interval (median patient age: 59 years [range 40-69 years]). The primary endpoint of this study was the inter-observer variability using kappa (κ) value.

RESULTS

Inter-observer variability for the four and two classes of breast-composition assessment revealed moderate agreement (Fleiss' κ: first and second reading = 0.553 and 0.587, respectively) and substantial agreement (Fleiss' κ: first and second reading = 0.689 and 0.70, respectively). Intra-observer variability for the four and two classes of breast-composition assessment demonstrated substantial agreement (Cohen's κ, median = 0.758) and almost perfect agreement (Cohen's κ, median = 0.813). Assessments of consensus between the 10 physicians and the automated software Volpara® revealed slight agreement (Cohen's κ; first and second reading: 0.104 and 0.075, respectively).

CONCLUSIONS

Qualitative visual assessment of mammographic breast composition using the new Japanese classification revealed excellent intra-observer reproducibility. However, persistent inter-observer variability, presenting a challenge in establishing it as the gold standard in Japan.

Investigation of distress during diffusion-weighted whole-body magnetic resonance imaging among women with breast cancer and the effectiveness of a new technology in alleviating patient's anxiety by approaching the human senses

INTRODUCTION

Breast cancer is a common malignant tumor among women, and the effectiveness of diagnosing its metastasis and recurrence has been demonstrated using diffusion-weighted whole-body imaging with background body signal suppression (DWIBS). However, DWIBS causes distress to patients due to the unique circumstances of magnetic resonance imaging (MRI). This study aimed to investigate the various distress factors caused by DWIBS among women with breast cancer and assess the effectiveness of a new MRI system designed with an environment incorporating relaxing technology.

METHODS

From May to September 2022, we conducted a questionnaire survey regarding DWIBS-related distress among women with breast cancer. The questionnaire was administered to participants who underwent DWIBS on a conventional MRI system (19 women) and on a new system (20 women) equipped with relaxing technology equipped features, including projection images, illumination, and sound. Participants rated the degree of various stress factors on a face-scale rating scale (0-10). The scores of both systems were compared using the Mann-Whitney U test.

RESULTS

In the conventional system, women experienced distress due to MRI-specific situations, such as immobility in a confined space, noise, feeling trapped, and concerns about not moving. These results did not show a specific tendency among women with breast cancer undergoing DWIBS. For almost all distress parameters, the new system had significantly lower distress scores than the conventional system (p > 0.05).

CONCLUSIONS

A comfortable environment using new and relaxing technology is effective in alleviating patient's anxiety by approaching the human senses.

IMPLICATIONS FOR PRACTICE

Reducing distress caused by DWIBS among women with breast cancer could provide a comfortable examination environment, potentially assisting them during longer treatment periods.

Use of machine learning with two-dimensional synthetic mammography for axillary lymph node metastasis prediction in breast cancer: a preliminary study

Background

As of 2020, breast cancer is the most common type of cancer and the fifth most common cause of cancer-related deaths worldwide. The non-invasive prediction of axillary lymph node (ALN) metastasis using two-dimensional synthetic mammography (SM) generated from digital breast tomosynthesis (DBT) could help mitigate complications related to sentinel lymph node biopsy or dissection. Thus, this study aimed to investigate the possibility of predicting ALN metastasis using radiomic analysis of SM images.

Methods

Seventy-seven patients diagnosed with breast cancer using full-field digital mammography (FFDM) and DBT were included in the study. Radiomic features were calculated using segmented mass lesions. The ALN prediction models were constructed based on a logistic regression model. Parameters such as the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results

The FFDM model yielded an AUC value of 0.738 [95% confidence interval (CI): 0.608-0.867], with sensitivity, specificity, PPV, and NPV of 0.826, 0.630, 0.488, and 0.894, respectively. The SM model yielded an AUC value of 0.742 (95% CI: 0.613-0.871), with sensitivity, specificity, PPV, and NPV of 0.783, 0.630, 0.474, and 0.871, respectively. No significant differences were observed between the two models.

Conclusions

The ALN prediction model using radiomic features extracted from SM images demonstrated the possibility of enhancing the accuracy of diagnostic imaging when utilised together with traditional imaging techniques.

Radiomics model of diffusion-weighted whole-body imaging with background signal suppression (DWIBS) for predicting axillary lymph node status in breast cancer

BACKGROUND

In breast cancer diagnosis and treatment, non-invasive prediction of axillary lymph node (ALN) metastasis can help avoid complications related to sentinel lymph node biopsy.

OBJECTIVE

This study aims to develop and evaluate machine learning models using radiomics features extracted from diffusion-weighted whole-body imaging with background signal suppression (DWIBS) examination for predicting the ALN status.

METHODS

A total of 100 patients with histologically proven, invasive, clinically N0 breast cancer who underwent DWIBS examination consisting of short tau inversion recovery (STIR) and DWIBS sequences before surgery were enrolled. Radiomic features were calculated using segmented primary lesions in DWIBS and STIR sequences and were divided into training (n = 75) and test (n = 25) datasets based on the examination date. Using the training dataset, optimal feature selection was performed using the least absolute shrinkage and selection operator algorithm, and the logistic regression model and support vector machine (SVM) classifier model were constructed with DWIBS, STIR, or a combination of DWIBS and STIR sequences to predict ALN status. Receiver operating characteristic curves were used to assess the prediction performance of radiomics models.

RESULTS

For the test dataset, the logistic regression model using DWIBS, STIR, and a combination of both sequences yielded an area under the curve (AUC) of 0.765 (95% confidence interval: 0.548-0.982), 0.801 (0.597-1.000), and 0.779 (0.567-0.992), respectively, whereas the SVM classifier model using DWIBS, STIR, and a combination of both sequences yielded an AUC of 0.765 (0.548-0.982), 0.757 (0.538-0.977), and 0.779 (0.567-0.992), respectively.

CONCLUSIONS

Use of machine learning models incorporating with the quantitative radiomic features derived from the DWIBS and STIR sequences can potentially predict ALN status.

Evaluation of imaging findings and prognostic factors after whole-brain radiotherapy for carcinomatous meningitis from breast cancer: A retrospective analysis

This study aimed to evaluate the imaging findings and prognostic factors after whole-brain radiotherapy in patients with carcinomatous meningitis from breast cancer.A retrospective analysis of imaging data and prognostic factors was performed in patients treated with whole-brain radiotherapy or whole-brain/spine radiotherapy immediately after the first diagnosis of carcinomatous meningitis from breast cancer at our hospital from January 1, 2010 to December 31, 2018. Statistical significance was set at P < .05 (two-tailed).All patients (n = 31) were females with the mean age of 58.0 ± 11.0 years. The breast cancer subtypes were luminal (n = 14, 45.1%), human epidermal growth factor receptor 2 (HER2)-positive (n = 9, 29.0%), and triple-negative (n = 8, 26.0%) breast cancer. Brain metastasis and abnormal contrast enhancement in the sulci were observed in 21 (67.7%) and 24 (80.6%) patients, respectively. The median survival time after cancerous meningitis diagnosis was 62 (range, 6-657) days. Log-rank test showed significant differences in median survival time after cancerous meningitis diagnosis: 18.0 days for subjects treated with 30 Gy in < 10 fractions (n = 7) vs 78.5 days for subjects treated with 30 Gy in ≥10 fractions (n = 24) (P < .01) and 23.0 days for the triple-negative subtype vs 78.5 days for the other subtype (P < .01) groups. Univariate analysis using the Cox regression model showed significant differences in median survival time after cancerous meningitis diagnosis between the group treated with 30 Gy in <10 fractions and the group treated in ≥10 fractions (hazard ratio [HR] 0.08, 95% confidence interval [CI], 0.03-0.26; P < .01), and between the triple-negative subtype and the other subtypes (HR = 5.48; 95% CI, 1.88-16.0; P < .01) groups.Discontinuation of whole-brain radiotherapy and the presence of triple-negative breast cancer were indicators of poor prognosis.

Survival time and prognostic factors after whole-brain radiotherapy of brain metastases from of breast cancer

Background

Breast cancer has a poor prognosis due to the high risk of distant metastasis.

Purpose

To identify the prognosticators of brain metastasis from breast cancer treated by whole-brain radiotherapy.

Material and Methods

We evaluated patients diagnosed with primary brain metastasis without carcinomatous meningitis from breast cancer and had undergone whole-brain radiotherapy as initial treatment between 1 January 2010 and 30 September 2019. We investigated associations between overall survival time from diagnosis using cranial contrast-enhanced magnetic resonance imaging (MRI)/computed tomography (CT) and the following parameters: (i) age; (ii) sex; (iii) time to appearance of brain metastasis; (iv) other metastasis at appearance of brain metastasis; (v) blood test; (vi) symptoms at time of brain metastasis; (vii) whole-brain radiotherapy dose; (viii) whether whole-brain radiotherapy was completed; (ix) course of chemo- or radiotherapy; (x) subtype; (xi) additional irradiation after whole-brain radiotherapy; (xii) pathology; and (xiii) imaging findings.

Results

We evaluated 29 consecutive female patients (mean age 55.2 ± 12.1 years). Median overall survival time after diagnosis on cranial contrast-enhanced MRI/CT was 135 days (range 16–2112 days). Multivariate stepwise analysis of the three parameters of lactate dehydrogenase, dose, and subtype identified the following significant differences: Hazard Ratio (HR) for dose (discontinued, 30 Gy/10 fractions, 31.5 Gy/11 fractions, 32.5 Gy/11 fractions, 37.5 Gy/15 fractions) was 0.08 (95% confidence interval [CI] 0.02–0.30, P < 0.01), and HR for subtype (luminal, HER2, triple-negative) was 2.70 (95% CI 1.16–6.243, P < 0.01).

Conclusion

HER2-type and 37.5 Gy/15 fractions are good prognostic factor after whole-brain radiotherapy in breast cancer with brain metastases.

Trastuzumab Emtansine (T-DM1) Plus S-1 in Patients with Trastuzumab-Pretreated HER2-Positive Advanced or Metastatic Breast Cancer: A Phase Ib Study

BACKGROUND

In treating human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer, the efficacy of capecitabine combined with HER2-directed agents such as trastuzumab and lapatinib is supported by some evidence. The combination of T-DM1 and S-1, another oral 5-FU, may be a safe alternative treatment for metastatic breast cancer.

OBJECTIVES

The optimal dose of S-1 was evaluated in combination with T-DM1 for patients with HER2-positive advanced or metastatic breast cancer. The safety and clinical response of this combination treatment were also assessed.

METHODS

This 3 + 3 dose-escalation study of S-1 given for the first 2 of 3 weeks, in combination with T-DM1 (3.6 mg/kg given every 3 weeks) to patients with trastuzumab-pretreated HER2-positive advanced or metastatic breast cancer was designed to evaluate the dose-limiting toxicity (DLT) occurrence in the first cycle. We also evaluated the safety and clinical activity of this combination treatment in multiple cycles. Two different dose levels of S-1 (65 and 80 mg/m2/day) were planned, although the capecitabine arm was abandoned because of slow recruitment.

RESULTS

Twelve out of the 13 patients enrolled were evaluable for DLT. One DLT (grade ≥3 non-hematological adverse events) occurred at dose level 0, leading to the expansion of this cohort to 6 patients, with an additional DLT (≥7 days discontinuation of medication), while no DLT occurred at dose level 1. As a result, the maximum tolerable dose of S-1 was determined to be 80 mg/m2/day for 14 days with T-DM1 3.6 mg/kg, repeated every 3 weeks. Two patients had grade 3 thrombocytopenia at dose level 0, and 1 patient at dose level 1.

CONCLUSIONS

S-1 can be safely combined with the clinically relevant dose of T-DM1 in patients with HER2-positive advanced or metastatic breast cancer. Further evaluation with a larger sample size is required for efficacy assessment.

Use of immunohistochemical analysis of CK5/6, CK14, and CK34betaE12 in the differential diagnosis of solid papillary carcinoma in situ from intraductal papilloma with usual ductal hyperplasia of the breast

Objectives:

The aim of this study was to use immunohistochemistry to differentiate solid papillary carcinoma in situ from intraductal papilloma with usual ductal hyperplasia (IPUDH). Three types of high-molecular-weight cytokeratins (CKs) – CK5/6, CK14, and CK34betaE12 – were targeted.

Methods:

We studied 17 patients with solid papillary carcinoma in situ and 18 patients with IPUDH diagnosed by at least two pathologists. Immunohistochemical analyses used antibodies to CK5/6, CK14, and CK34betaE12 to make the differential diagnosis of solid papillary carcinoma in situ versus IPUDH. Immunohistochemical staining was scored as 0–5 using Allred score.

Results:

Immunohistochemistry with CK5/6 and CK14 antibodies produced scores of 0–3 in all patients with solid papillary carcinoma in situ and 2–5 in all patients with IPUDH. Immunohistochemical staining with CK34betaE12 antibody produced scores of 1–3 in all patients with solid papillary carcinoma and 3–5 in all patients with IPUDH. In tissues from patients with IPUDH, significantly more cells were stained with CK34betaE12 than CK5/6 (p < 0.05) or CK14 (p < 0.05).

Conclusion:

The immunoreactivity of CK5/6, CK14, and CK34betaE12 antibodies was useful to differentiate solid papillary carcinoma in situ from IPUDH. CK34betaE12 is especially useful for distinguishing solid papillary carcinoma from IPUDH.

Grading system to categorize breast MRI using BI-RADS 5th edition: a statistical study of non-mass enhancement descriptors in terms of probability of malignancy

PURPOSE

To analyze the association of breast non-mass enhancement descriptors in the BI-RADS 5th edition with malignancy, and to establish a grading system and categorization of descriptors.

MATERIALS AND METHODS

This study was approved by our institutional review board. A total of 213 patients were enrolled. Breast MRI was performed with a 1.5-T MRI scanner using a 16-channel breast radiofrequency coil. Two radiologists determined internal enhancement and distribution of non-mass enhancement by consensus. Corresponding pathologic diagnoses were obtained by either biopsy or surgery. The probability of malignancy by descriptor was analyzed using Fisher's exact test and multivariate logistic regression analysis. The probability of malignancy by category was analyzed using Fisher's exact and multi-group comparison tests.

RESULTS

One hundred seventy-eight lesions were malignant. Multivariate model analysis showed that internal enhancement (homogeneous vs others, p < 0.001, heterogeneous and clumped vs clustered ring, p = 0.003) and distribution (focal and linear vs segmental, p < 0.001) were the significant explanatory variables. The descriptors were classified into three grades of suspicion, and the categorization (3, 4A, 4B, 4C, and 5) by sum-up grades showed an incremental increase in the probability of malignancy (p < 0.0001).

CONCLUSION

The three-grade criteria and categorization by sum-up grades of descriptors appear valid for non-mass enhancement.

Effectiveness of computer-aided diagnosis (CADx) of breast pathology using immunohistochemistry results of core needle biopsy samples for synaptophysin, oestrogen receptor and CK14/p63 for classification of epithelial proliferative lesions of the breast

Aims

The aim of this study was to develop a computer-aided diagnosis (CADx) system for identifying breast pathology.

Methods

Two sets of 100 consecutive core needle biopsy (CNB) specimens were collected for test and validation studies. All 200 CNB specimens were stained with antibodies targeting oestrogen receptor (ER), synaptophysin and CK14/p63. All stained slides were scanned in a whole-slide imaging system and photographed. The photographs were analysed using software to identify the proportions of tumour cells that were positive and negative for each marker. In the test study, the cut-off values for synaptophysin (negative and positive) and CK14/p63 (negative and positive) were decided using receiver operating characteristic (ROC) analysis. For ER analysis, samples were divided into groups with <10% positive or >10% positive cells and decided using receiver operating characteristic (ROC) analysis. Finally, these two groups categorised as ER-low, ER-intermediate (non-low and non-high) and ER-high groups. In the validation study, the second set of immunohistochemical slides were analysed using these cut-off values.

Results

The cut-off values for synaptophysin, <10% ER positive, >10% ER positive and CK14/p63 were 0.14%, 2.17%, 77.93% and 18.66%, respectively. The positive predictive value for malignancy (PPV) was 100% for synaptophysin-positive/ER-high/(CK14/p63)-any or synaptophysin-positive/ER-low/(CK14/p63)-any. The PPV was 25% for synaptophysin-positive/ER-intermediate/(CK14/p63)-positive. For synaptophysin-negative/(CK14/p63)-negative, the PPVs for ER-low, ER-intermediate and ER-high were 100%, 80.0% and 95.8%, respectively. The PPV was 4.5% for synaptophysin-negative/ER-intermediate/(CK14/p63)-positive.

Conclusion

The CADx system was able to analyse sufficient data for all types of epithelial proliferative lesions of the breast including invasive breast cancer. This system may be useful for pathological diagnosis of breast CNB in routine investigations.

Oncologic outcomes and technical considerations of nipple-sparing mastectomies in breast cancer: experience of 425 cases from a single institution

BACKGROUND

Nipple-sparing mastectomy (NSM) is an advantageous treatment option, providing a complete cure and good cosmetic results. We tested whether NSM is a surgically and oncologically safe technique.

METHODS

We evaluated the oncological outcome of 425 breasts in 413 patients who underwent NSM between January 2000 and March 2013. We retrospectively reviewed patient data and analyzed all patient characteristics as potential risk factors of recurrence at the nipple-areola complex (NAC). To confirm the oncological safety of NSM, we compared outcomes of NSM and conventional total mastectomy.

RESULTS

The median follow-up time after surgery was 46.8 months (range 6-158 months). Nipple necrosis was observed in 6 cases (1.4 %). The cumulative local recurrence rate after NSM was 5.8 % (25/425 cases), similar to that of conventional total mastectomy in the same period (5.6 %, 49/878 cases). Furthermore, the cumulative local recurrence rate at the NAC was 2.3 % (10 cases). HER2-enriched tumors and young age (<40 years) were significant risk factors for recurrence at the NAC. In patients with recurrence, the site of recurrence was easily excised, and good cosmetic results were achieved in breast reconstruction cases.

CONCLUSION

NSM is safe with a low complication rate. No significant difference was observed in cumulative local recurrence rate, cumulative distant disease recurrence rate, and overall survival between patients who underwent NSM or conventional total mastectomy, confirming that NSM was surgically and oncologically safe.

Magnetic resonance examination to predict pathological complete response following neoadjuvant chemotherapy: when is it appropriate for HER2-positive and triple-negative breast cancers?

BACKGROUND

To clarify appropriate timing for magnetic resonance examination to predict pathological complete response to neoadjuvant chemotherapy for patients with human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancers in terms of tumor volume change.

METHODS

Between September 2009 and December 2014, 113 women with HER2-positive (n = 51) and triple-negative (n = 62) invasive breast cancers undergoing neoadjuvant chemotherapy were enrolled. Patients with HER2-positive tumors underwent neoadjuvant chemotherapy with an anthracycline-based regimen followed by docetaxel with trastuzumab. Patients with triple-negative tumors underwent neoadjuvant chemotherapy with anthracycline-based (first in most cases) and taxane-based regimens. Magnetic resonance imaging was performed before neoadjuvant chemotherapy, between the regimens (midpoint examination), and after neoadjuvant chemotherapy (final examination). Response ratio of tumor volume was calculated and receiver-operating characteristic analyses for them for both subtypes were performed at the midpoint and final examinations.

RESULTS

Twenty-eight women with HER2-positive tumors (54.9 %) and 29 women with triple-negative tumors (46.8 %) had pathological complete response. The response ratios were better in cases with pathological complete response than in those without (p = 0.0341, p < 0.0001). The area under the curve at the final examination was higher than that at the midpoint examination for HER2-positive tumors (p = 0.039); whereas for the triple-negative tumors, no significant difference between the two examinations was shown (p = 0.5218).

CONCLUSIONS

Magnetic resonance examination to predict pathological complete response would be feasible after completion of a regimen including trastuzumab for HER2-positive tumors and at the midpoint of neoadjuvant chemotherapy for triple-negative tumors.

Positive predictive value for malignancy of pure flat epithelial atypia diagnosis by percutaneous needle biopsy of the breast: management of FEA in ultrasonography

BACKGROUND

Some reports suggest that the rate of definitive diagnosis of malignant tumors, namely, the final diagnosis being revised to a higher stage, in patients diagnosed as having flat epithelial atypia (FEA) by percutaneous needle biopsy of the breast (PNB) is as low as 0-3 %. However, other reports suggest that the rate is as high as 10 % or more, bringing confusion on this issue. We examined the positive predictive value for malignancy in the patients diagnosed as having pure FEA and the patients' radiolopathological characteristics observed in our hospital.

METHODS

Of the patients who underwent PNB in our facility, those who were diagnosed as having pure FEA were recruited as the subjects of this study.

RESULTS

Of the 4,197 consecutive patients who underwent PNB, 44 (1.0 %) were diagnosed as having pure FEA following a re-examination. Among 44 cases, 39 cases were selected as the subjects of this study. Among the 39 patients, six patients were diagnosed as having malignant lesions, two of whom had invasive carcinoma of no special type (papillotubular type), one had tubular carcinoma, one had ductal carcinoma in situ (DCIS) of high nuclear grade, one had DCIS of intermediate nuclear grade, and one had DCIS of low nuclear grade. The diameters of 6 malignant lesions were 10-30 mm at ultrasonography (US) examination. Five of the 39 patients had contralateral breast cancer.

CONCLUSION

The positive predictive value for malignancy of pure FEA was 15.7 %. The patients with pure FEA may make a follow up without an excisional biopsy when the lesion sizes less than 10 mm on US examination.

Clinical efficacy and value of redistributed subclavian arterial infusion chemotherapy for locally advanced breast cancer

PURPOSE

The aim of this study was to evaluate the efficacy and safety of redistributed subclavian arterial infusion chemotherapy (RESAIC). We have focused on the local response, quality of life (QOL), and complications. We have also investigated factors that influence the local response of RESAIC.

MATERIALS AND METHODS

The subjects were patients with locally advanced breast cancer whose tumors were resistant to standard systemic chemotherapy (at least more than two regimens), those who were physically unable to tolerate systemic chemotherapy, and patients with locally recurrent breast cancer. The registration period was between April 2006 and May 2009.

RESULTS

A total of 24 cases in 22 patients (mean age 59.5 years, range 36-82 years) were entered in the study. The local response rate of RESAIC was 77.3% (17/22). The QOL score showed improvement on average. There were no serious complications during catheter port implantation, and there was hematological toxicity over grade 3 in 27.3% (6/22) of patients. A significant difference between responders and nonresponders was seen in patients with a replaced type tumor (on imaging, diffuse contrast enhancement was seen in whole quadrants) (P = 0.043), and the patients underwent radiotherapy (P = 0.043).

CONCLUSION

RESAIC is an effective, safe treatment for locally advanced breast cancer. Because it was reviewed in only a few cases, however, large-scale studies are warranted.

A case of a fibroadenoma coexisting with an invasive lobular carcinoma in the breast

A case of a fibroadenoma coexisting with an invasive lobular carcinoma of the breast in a 60-year-old female is presented, and its pathological features are correlated with high-resolution magnetic resonance imaging (HR-MRI) and other imaging findings. The patient presented with the chief complaint of having a palpable mass in her right breast for 3 months. Mammography revealed a lobular mass with a micro-lobulated margin, which suggested a malignant nature; however, it included coarse calcifications. Sonographic imaging and HR-MRI findings were compatible with malignant tumor. Cytology was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery was performed as a curative operation. The pathological features revealed a fibroadenoma coexisting with an invasive lobular carcinoma. This case suggests that radiologists should always pay attention to the associated malignant imaging characteristics, such as the shape and border of the mass, whenever a mass demonstrates benign-like calcifications.

Use of ultrasonography as an alternative modality for first-line examination in detecting breast cancer in selected patients

BACKGROUND

Detecting lesions in dense breast tissue can be difficult when using mammography. If a patient can be identified as having an increased likelihood of having dense breast tissue based on background factors, ultrasonography can be selected as an alternative method to detect lesions efficiently. We focused on age and reproductive history as factors that determine whether mammography or ultrasonography should be used first.

PATIENTS AND METHODS

We retrospectively examined 193 breasts in 192 patients (1 case of bilateral breast cancer) who had undergone surgery and received a histopathologic diagnosis of breast cancer. Patients were divided into the 2 following groups based on age: 40-49 years and > or = 50 years. These groups were then subdivided based on reproductive history as follows: no history of pregnancy, < 3 parturitions (excluding no history of pregnancy), and > or = 3 parturitions. Sensitivities were then compared among the 6 groups.

RESULTS

Significant differences in sensitivities were found between mammography and ultrasonography in 3 groups: patients aged 40-49 years with no history of pregnancy; patients aged 40-49 years with a history of < 3 parturitions; and patients aged > or = 50 years with no history of pregnancy. Limiting the results to these groups, sensitivities were 51.5% (34 of 66 cases) with mammography and 81.8% (54 of 66 cases) with ultrasonography.

CONCLUSION

We suggest that ultrasonography be used as a first-line examination in detecting breast cancer in such patients; however, this must be confirmed in a future upscale study using larger numbers of subdivided groups.

High-resolution MRI in detecting subareolar breast abscess

OBJECTIVE

Because subareolar breast abscess has a high recurrence rate, a more effective imaging technique is needed to comprehensively visualize the lesions and guide surgery. We performed a high-resolution MRI technique using a microscopy coil to reveal the characteristics and extent of subareolar breast abscess.

CONCLUSION

High-resolution MRI has potential diagnostic value in subareolar breast abscess. This technique can be used to guide surgery with the aim of reducing the recurrence rate.

Ductal carcinoma in situ: correlations between high-resolution magnetic resonance imaging and histopathology

PURPOSE

The aim of this retrospective study was to determine and correlate contrast-enhanced areas and multiple internal dark dots and lines on high-resolution magnetic resonance imaging (HR-MRI) with findings in surgical specimens of ductal carcinoma in situ (DCIS) and to evaluate the ability of HR-MRI to detect DCIS lesions and clarify HR-MRI features characteristic of DCIS.

MATERIALS AND METHODS

This study retrospectively reviewed 11 patients diagnosed with DCIS who had undergone HR-MRI. Pathological findings and results of HR-MRI were compared, and causes of periductal enhancements were analyzed.

RESULTS

In all patients, HR-MRI using microscopic coils revealed ductally, segmentally, or regionally enhanced areas containing multiple dark dots and lines, representing local enhancement of stroma adjacent to the mammary duct containing DCIS. Neovascularization, infiltration of inflammatory cells, and focal edema occurred in enhanced periductal stroma. Poorly enhanced linear or dot-like structures correlated with dilated mammary ducts displaying necrosis and tumor impaction.

CONCLUSION

DCIS was successfully depicted on HR-MRI using a microscopy coil in all 11 cases. Ductal, segmental, or regional areas of enhancement with multiple dark dots and lines on HR-MRI corresponded to mammary glands containing DCIS with periductal enhancement.

Diagnostic accuracy of high-resolution MRI using a microscopy coil for patients with presumed DCIS following mammography screening

PURPOSE

To prospectively evaluate the accuracy of high-resolution (HR)-MRI as a secondary examination in women with abnormal calcifications detected on mammography.

MATERIALS AND METHODS

We used a 4.7-cm microscopy coil to acquire HR-MRI signal data. We examined 52 women with breast lesions preoperatively using HR-MRI and vacuum-assisted core needle biopsy. The lesions were suspicious of malignancy, classified as category 3-5 on mammography (Breast Imaging Reporting and Data System [BI-RADS]), and without a palpable mass. All visualized suspicious lesions were correlated with histological findings. We compared the HR-MRI and pathological findings and calculated the sensitivity, specificity, and accuracy.

RESULTS

We compared the breast HR-MRI results with the gold standard of pathological results for studies of malignancy (DCIS and invasive cancer), and found a sensitivity of 88.5%, specificity of 92.3%, and accuracy of 90.4%. The positive predictive value (PPV) was 92%, and the negative predictive value (NPV) was 88.9%. When breast MRI was compared with pathological results for studies that diagnosed DCIS only, the results revealed a sensitivity of 88.6%, specificity of 88.2%, accuracy of 88.5%, PPV of 93.9%, and NPV of 78.9%.

CONCLUSION

HR-MRI using a microscopy coil is a useful, reliable, safe, and minimally invasive procedure that is a good choice for secondary assessment of abnormal calcification in the breast.

Intraductal Papilloma: Features on MR Ductography Using a Microscopic Coil

OBJECTIVE

The purpose of this study was to describe the features of intraductal papilloma on MR ductography using a microscopic coil.

CONCLUSION

Intraductal papilloma appeared in most cases as a well-circumscribed mass with early enhancement and delayed washout associated with a dilated duct, predominantly showing signal hyperintensity on T1- and T2-weighted imaging.

Structural inhomogeneity in mammography quality control phantoms detected by refraction-enhanced synchrotron radiation imaging

Synchrotron radiation imaging with the refraction-enhancement mode visualized structural inhomogeneities in phantoms used for image quality control of mammography. Eight phantoms were examined, all of which were manufactured in the United States and approved by the American College of Radiology as dedicated phantoms. In addition to fiber- and mass-mimicking test objects, each phantom has 5 groups of calcification specks of various sizes. Synchrotron radiation (SR) imaging was performed at Spring-8, a synchrotron radiation facility in Japan. Images were obtained with monochromatic 20-keV x-ray beams, a radiation field of 15 mm X 26 mm at a sample plane, a CCD camera with a resolution of 6 micrometers as a detector, and a sample-to-detector distance of 10 to 11 m. Two hundred and forty specks were evaluated in total in the SR images, and the surrounding area of each speck was also included. Evaluation of the images showed that 14 crack-like structures were depicted near specks, and there were 62 specks with attached void(s) or air bubble(s). Refraction-enhanced SR imaging sensitively detected structural inhomogeneities and abnormalities in phantoms which were implicitly agreed to have a homogeneous matrix and test objects without foreign substances. A possible manufacturing-dependent quality issue was identified. The effect of inhomogeneities detected by SR imaging on visual scoring of specks could not be identified in the tested phantoms; this should be assessed on images of other phantoms in a future study.

Defects of a mammography quality control phantom visualized by synchrotron radiation imaging

Synchrotron radiation (SR) imaging of an RMI 156 mammography quality control phantom, serial number 156-15330, revealed some defects which degraded the visibility of calcification specks. SR imaging was performed at SPring-8, in Harima, Japan by using a monochromatic energy of 20 KeV with a field-of-view of 24 X 24 mm. Different kinds of images were obtained by changing sample-to-detector distances; absorption images and refraction-enhanced images. Specks were embedded in a wax matrix and were imaged as black in an absorption image. In a refraction-enhanced image, they were imaged as a black region with white margins. Foreign objects with opposite contrast were detected near, or overlapped with, some specks. As they were depicted as white in the absorption images and as white with a black margin in the refraction-enhanced image, it seemed that they had low X-ray attenuation and a low refraction index compared with the surrounding wax. They might presumably be air bubbles. Visibility of specks in an absorption image was seriously interfered with when those object(s) overlapped with specks. This kind of defect may cause a difficulty in meeting quality assurance specifications when a facility inadvertently purchases defective phantoms.

Correlation of CT values, iodine concentration, and histological changes in the thyroid

PURPOSE

We have reported that in the thyroid, there is a linear correlation between iodine concentrations and CT values. However, the slope of the regression line was about three times as large as that in KI solutions. We investigated the factor(s) contributing to the increment of the slope of the regression line in the thyroid.

METHOD

Solutions of NH4I and thyroid hormones were used to investigate the regression line. Thirty-six thyroids were evaluated to investigate the correlation between the iodine concentrations and the area ratio of thyroid follicles, which were measured by preoperative CT and from tissue slices, respectively.

RESULTS

The slopes of the regression lines in the solutions were almost identical to those in KI solutions. In the thyroid, iodine concentrations were logarithmically correlated with the area ratio of follicles.

CONCLUSION

The decrease in CT values not only revealed a decrease of iodine concentration in the thyroid but also represented an increase of follicular cells and/or interstitial structures in the volume ratio secondary to it.