[Show abstract][Hide abstract] ABSTRACT: Purpose:
The purposes our study was to find out any histologic factors associated with negative conversion of axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC). We also evaluated the association between the decrease in size of primary breast tumor and negative conversion of ALN.
From January 2012 to November 2014, we included 133 breast cancer patients who underwent NAC and who had ALN metastases which were confirmed on fine-needle aspiration or core needle biopsy at initial diagnosis. All 133 patients underwent initial magnetic resonance imaging (MRI) at the time of diagnosis and preoperative MRI after completion of NAC. We measured the longest dimension of primary breast cancer on MRI.
Of 133 patients, 39 patients (29%) showed negative conversion of ALN and of these 39 patients, 25 patients (64%) showed pathologic complete remission of primary breast. On univariate analysis, mean percent decrease in longest dimension, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 status and histologic grade were significantly associated with the ALN status after NAC (p<0.001, p=0.001, p< 0.001, p=0.001, p=0.002, respectively). On multivariate logistic regression analysis, percent decrease in longest dimension (odds ratio, 1.026; 95% confidence interval [CI], 1.009-1.044) and histologic grade (odds ratio, 3.964; 95% CI, 1.151-13.657) were identified as being independently associated with the ALN status after NAC. The area under the receiver operating characteristic curve was 0.835 with the best cutoff value of 80% decrease in longest dimension. Combination of high histologic grade and more than 80% decrease in longest dimension showed 64% sensitivity and 92% specificity.
High histologic grade and more than 80% decrease in primary tumor dimension were associated with negative conversion of ALN after NAC.
Preview · Article · Dec 2015 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: We evaluated the relationship between coronary artery disease (CAD) and left ventricular mass (LVM) as measured by cardiac computed tomography (CT) in young adults ≤40 years of age. We retrospectively enrolled 490 consecutive individuals (383 males; mean age, 35.2 ± 4.4 years) who underwent cardiac CT. CAD was defined by the presence of any plaque detected by coronary CT angiography. Left ventricular (LV) function, including LVM, was automatically measured by a dedicated workstation. LVM and LVM index (LVMi) in patients with CT-detected CAD were compared to those of patients without CT-detected CAD. Logistic regression analysis was used to evaluate the relationship between cardiovascular risk factors and CAD. Fifty-five individuals had CT-detected CAD (11.2 %, 53 males). LVM measured by cardiac CT was 126.9 ± 30.0 g for males and 93.6 ± 20.9 g for females. LVM was higher (117.8 ± 30.8 vs. 133.6 ± 33.1 g, P < 0.001) in patients with CT-detected CAD compared with patients without CT-detected CAD. Obesity, hypertension, smoking, hypercholesterolemia, LVM and LVMi were predictors of CT-detected CAD. Body mass index (r = 0.237, P < 0.001) and systolic blood pressure (r = 0.281, P < 0.001) were positively correlated with LVM. In the multivariate analysis, LVM [odds ratio (OR) = 1.016] and LVMi (OR = 1.026) remained independent predictors of CAD. LVM and LVMi in patients with CT-detected CAD were higher than that of patients without CT-detected CAD. LVM and LVMi measured by cardiac CT were independent predictors of CAD.
No preview · Article · Oct 2015 · The international journal of cardiovascular imaging
[Show abstract][Hide abstract] ABSTRACT: To evaluate the diagnostic performance of ultrasound (US), magnetic resonance imaging (MRI) and F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis of metastatic axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC) and to find out histopathologic factors affecting the diagnostic performance of these imaging modalities.
From January 2012 to November 2014, 191 consecutive patients with breast cancer who underwent NAC before surgery were retrospectively reviewed. We included 139 patients with axillary lymph node metastasis which was confirmed on fine needle aspiration or core needle biopsy at initial diagnosis.
After NAC, 39 (28%) patients showed negative conversion of axillary lymph node on surgical specimens of sentinel lymph node or axillary lymph node. The sensitivity of US, MRI and PET/CT was 50% (48/96), 72% (70/97) and 22% (16/73), respectively. The specificity of US, MRI and PET-CT was 77% (30/39), 54% (21/39) and 85% (22/26), respectively. The Az value of combination of US and PET/CT was highest (0.634) followed by US (0.626) and combination of US, MRI and PET/CT (0.617). The size of tumor deposit in lymph node and estrogen receptor were significantly associated with the diagnostic performance of US (p<0.001 and p=0.009, respectively) and MRI (p=0.045 and p=0.036 respectively). The % diameter decrease, size of tumor deposit in lymph node, progesterone receptor, HER2 and histologic grade were significantly associated with the diagnostic performance of PET/CT (p=0.023, p=0.002, p=0.036, p=0.044 and p=0.008, respectively). On multivariate logistic regression analysis, size of tumor deposit within lymph node was identified as being independently associated with diagnostic performance of US [odds ratio, 13.07; 95% conﬁdence interval (CI), 2.95-57.96] and PET/CT [odds ratio, 6.47; 95% conﬁdence interval (CI), 1.407-29.737].
Combination of three imaging modalities showed highest sensitivity and PET/CT showed highest specificity for the evaluation of ALN metastasis after NAC. US alone or combination of US and PET/CT showed highest positive predictive value. The size of tumor deposit within ALN was significantly associated with diagnostic performance of US and PET/CT. Advances in knowledge: This study is about the diagnostic performance of US, MRI, PET/CT and combination of each imaging modalities for the evaluation of metastatic ALN after NAC. Of many histopathologic factors, only the size of tumor deposit within ALN was independent factor associated with the diagnostic performance of US and PET/CT.
Full-text · Article · May 2015 · The British journal of radiology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to establish possible relationships among the metabolic and vascular characteristics of breast cancer using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging.
Sixty-seven female patients with invasive ductal breast carcinoma (age 32-79 years) who underwent FDG PET/CT and DCE-MRI prior to cancer treatment were included in the study. The maximum standardized uptake value (SUVmax), metabolic tumor volume, total lesion glycolysis (TLG), and heterogeneity factor (HF) were derived from FDG PET/CT. The DCE-MRI parameters K trans, K ep, and V e were obtained for all tumors, and relationships between the metabolic and perfusion parameters were sought via Spearman's rank correlation analysis. The prognostic significance of clinicopathological and imaging parameters in terms of recurrence-free survival (RFS) was also evaluated.
No significant correlation between perfusion and metabolic parameters (p > 0.05) was found, except between SUVmax and V e (p = 0.001, rho = -0.391). Recurrence developed in 12 of the 67 patients (17.9 %, follow-up period 8-41 months). Age (p = 0.016) and HF (p = 0.027) were significant independent predictors of recurrence-free survival (RFS) upon multivariate analysis. The RFS of patients under 40 years of age was significantly poorer than that of older patients (p < 0.001). Survival of patients with more heterogeneous tumors (HF less than -0.12) was poorer than those with relatively homogenous tumors (p = 0.033).
Tumors with higher levels of glucose metabolism (SUVmax values) exhibited higher tumor cellularities (V e values). Also, of the various metabolic and perfusion parameters available, tumor heterogeneity measured via FDG PET/CT (HF) may be useful in predicting RFS in breast cancer patients.
Full-text · Article · Mar 2015 · Annals of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence of coronary anomalies using coronary computed tomography angiography (CCTA) and to evaluate the relationship between coronary artery anomalies and chest pain.
[Show abstract][Hide abstract] ABSTRACT: Objectives: The purpose of our study was to evaluate whether strong background parenchymal enhancement would be a significant independent factor associated with positive resection margin in patients treated initially with breast conserving surgery. Materials and Methods: Retrospective evaluation of breast MRI examinations of 314 patients with breast cancer was done. Breast cancer was histologically confirmed in all patients who underwent breast conserving surgery from January 2008 to December 2010. Background parenchymal enhancement was dichotomized into weak (minimal or mild) and strong (moderate or marked) enhancement for statistical analysis. Histopathologic features of attained specimens were evaluated by an experienced pathologist and were also dichotomized for statistical analysis. Results: On univariate analysis, positive extensive intraductal component (p<0.001), strong background parenchymal enhancement (p=0.001), and HER2 positivity (p=0.08) had significant association with positive surgical margin. Tumour size, axillary lymph node metastasis, nuclear grade, histologic grade, lymphovascular invasion, estrogen receptor and progesterone receptor did not show significant correlation with positive surgical margin. On multivariate analysis, the significant independent predictors were extensive intraductal component (Odds ratio 5.68; 95% CI 2.72-11.82) and strong background parenchymal enhancement (Odds Ratio 2.39; 95% CI 1.2-4.78). Conclusion: Strong background parenchymal enhancement is significant independent factor for positive resection margin along with positive extensive intraductal component, and performing MRI during the period of lower parenchymal enhancement is needed in patients with strong background parenchymal enhancement. Advances in knowledge: As far as we know, this is the first study to reveal that BPE is a significant independent factor associated with positive resection margin.
No preview · Article · Nov 2014 · British Journal of Radiology
[Show abstract][Hide abstract] ABSTRACT: Objectives
To investigate the prevalence of simple pulmonary eosinophilia (SPE) and validate CT findings of SPE found on follow-up CT of oncologic patients
We retrospectively reviewed 6977 cases of oncologic patients who underwent chest CT. A total of 66 individuals who met criteria for having SPE were identified. CT scans were fully re-assessed by consensus of 2 radiologists in terms of characteristics of pulmonary lesions.
The prevalence of SPE was 0.95%. A total of 193 lesions were identified and most of the lesions showed part-solid pattern (69.9%), round to ovoid contour (46.1%), ill-defined margin (90.2%), or partial halo appearance (74.8%). In addition, almost half of the lesions showed the vascular contact (49%). SPE appeared as either solitary (42.4%) or multiple lesions (57.6%). The majority of lesions were located in the periphery (76.2%), and lower lung zonal (67.4%) predominance was found.
The frequency of SPE in oncologic patients with CT findings of GGO, part-solid lesion was high (17.5%). Therefore, when key features of CT findings suggesting SPE (part-solid nodule; ill-defined margin; peripheral distribution; and lower lung zone predominance) are newly discovered on follow-up chest CT in oncologic patients, it would be useful to correlate with blood test and do short-term follow-up in order to avoid unnecessary invasive procedure.
No preview · Article · Oct 2014 · European Journal of Radiology
[Show abstract][Hide abstract] ABSTRACT: To find out any correlation between dynamic contrast-enhanced (DCE) model-based parameters and model-free parameters, and evaluate correlations between perfusion parameters with histologic prognostic factors.
Model-based parameters (Ktrans, Kep and Ve) of 102 invasive ductal carcinomas were obtained using DCE-MRI and post-processing software. Correlations between model-based and model-free parameters and between perfusion parameters and histologic prognostic factors were analysed.
Mean Kep was significantly higher in cancers showing initial rapid enhancement (P = 0.002) and a delayed washout pattern (P = 0.001). Ve was significantly lower in cancers showing a delayed washout pattern (P = 0.015). Kep significantly correlated with time to peak enhancement (TTP) (ρ = -0.33, P < 0.001) and washout slope (ρ = 0.39, P = 0.002). Ve was significantly correlated with TTP (ρ = 0.33, P = 0.002). Mean Kep was higher in tumours with high nuclear grade (P = 0.017). Mean Ve was lower in tumours with high histologic grade (P = 0.005) and in tumours with negative oestrogen receptor status (P = 0.047). TTP was shorter in tumours with negative oestrogen receptor status (P = 0.037).
We could acquire general information about the tumour vascular physiology, interstitial space volume and pathologic prognostic factors by analyzing time-signal intensity curve without a complicated acquisition process for the model-based parameters.
• Kep mainly affected the initial and delayed curve pattern in time-signal intensity curve. • There is significant correlation between model-based and model-free parameters. • We acquired information about tumour vascular physiology, interstitial space volume and prognostic factors.
No preview · Article · Feb 2014 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: Objective:
The purpose of this study was to validate the usefulness of MDCT for diagnosis of a sharp or pointed esophageal foreign body according to esophageal level.
Materials and methods:
Forty-two patients with a history of sharp or pointed foreign body ingestion were reviewed retrospectively. Two observers interpreted the CT and the conventional radiography datasets separately. If a foreign body was directly identified, it was regarded as a positive finding. Even if no high-density foreign body was found, detection of a secondary finding was considered to be a positive finding. Diagnostic performance of MDCT and conventional radiography were compared according to esophageal level. Final diagnosis was made by esophagoscopy or surgery in addition to the clinicoradiologic result.
MDCT was statistically superior to conventional radiography for diagnosis of a thoracic esophageal foreign body for both observers (p < 0.001 for each). No significant difference in sensitivity between CT and conventional radiography for diagnosis of cervical esophageal foreign body was noted regardless of observer. Both observers could identify all complicated conditions with MDCT regardless of esophageal level. However, in two of three cases of complicated thoracic esophageal foreign bodies, neither observer could detect foreign bodies on conventional radiography; furthermore, the observers could not identify pneumomediastinum.
In cases of sharp or pointed foreign body ingestion, if the result of an initial inspection of oro- and hypopharynx reveals negative findings, the first imaging modality should be MDCT for better diagnosis and management.
No preview · Article · Nov 2013 · American Journal of Roentgenology
[Show abstract][Hide abstract] ABSTRACT: MRI and PET/CT are useful for assessing breast cancer patients after neoadjuvant chemotherapy (NAC).
To investigate the utility of MRI and PET/CT in the prediction of pathologic response to neoadjuvant chemotherapy using Miller-Payne grading system in patients with breast cancer.
From January 2008 to December 2010, 59 consecutive patients with pathologically proven breast cancer, who underwent neoadjuvant chemotherapy followed by surgery were retrospectively enrolled. The maximal diameter decrease rate and volume reduction rate by three-dimensional (3D) MRI and standardized uptake value (SUV) reduction rate by PET/CT were calculated and correlated with the Miller-Payne grading system using the Spearman rank correlation test. Patients with Miller-Payne grades 1 or 2 were classified into the non-responder group and patients with grades 3, 4, and 5 were in the responder group. To differentiate between responders and non-responders, receiver-operating characteristic (ROC) analysis was performed.
The volume reduction rate was 64.87 ± 46.95, diameter decrease rate was 48.09 ± 35.02, and SUV decrease rate was 62.10 ± 32.17. Among three parameters, the volume reduction rate was most correlated with histopathologic grades of regression (ρ = 0.755, P <0.0001) followed by diameter decrease rate (ρ = 0.660, P < 0.0001), and SUV decrease rate of primary breast mass (ρ = 0.561, P = 0.0002). The area under the ROC curve (Az) value was largest in the volume reduction rate (Az = 0.9), followed by SUV decrease rate (Az = 0.875), and diameter decrease rate (Az = 0.849). The best cut-offs for differentiating responders from non-responders in the ROC curve analysis were a 50% decrease in diameter, 68.9% decrease in volume, and 60.1% decrease in SUV after NAC.
Volumetric measurement using 3D MRI combined with conventional diameter measurement may be more accurate to evaluate pathologic response after NAC.
[Show abstract][Hide abstract] ABSTRACT: Neoadjuvant chemotherapy is the standard treatment for patients with locally advanced breast cancer and is increasingly considered for patients with operable disease. Recently, as many clinical trials have demonstrated favorable outcomes of anthracycline-taxane based regimen, this approach has been widely used in the neoadjuvant setting.
We compared women who received adriamycine and docetaxel (AD) with adriamycin, cyclophosphamide followed by paclitaxel (AC-T) as neoadjuvant chemotherapy. The AD group was scheduled for six cycles of AD (50 mg/m(2) and 75 mg/m(2), respectively) at a 3-week interval. The AC-T group was scheduled for four cycles of adriamycin and cyclophosphamide (50 mg/m(2) and 500 mg/m(2), respectively) followed by four cycles of paclitaxel (175 mg/m(2)) at a 3-week interval.
The responses of chemotherapy were equivalent (overall response rate [AD, 75.7% vs. AC-T, 80.9%; P = 0.566], pathologic complete response [pCR] rate [breast and axilla: AD, 10.8% vs. AC-T, 12.8%; P = 1.000; breast only: AD, 18.9% vs. AC-T, 14.9%, P = 0.623], breast conserving surgery rate [P = 0.487], and breast conserving surgery conversion rate [P = 0.562]). The pCR rate in the breast was higher in the human epidermal growth factor receptor 2 (HER2) positive cases (HER2 positive 33.3% vs. negative 10%, P = 0.002). Although nonhematologic toxicities were comparable, hematologic toxicities were more severe in the AD group. Most women in the AD group suffered from grade 3/4 neutropenia (P < 0.001) and neutropenic fever (P < 0.001).
Tumor responses were not different in various variables between the two groups. However, AC-T was a more tolerable regimen than AD in patients with breast cancer receiving neoadjuvant chemotherapy.
Full-text · Article · Jul 2013 · Journal of the Korean Surgical Society
[Show abstract][Hide abstract] ABSTRACT: Purpose:
This study examined the ability of magnetic resonance imaging (MRI) enhancement features to predict the response to neoadjuvant chemotherapy (NAC) in patients with breast cancer.
This retrospective study included 107 patients with breast cancer. All patients underwent a baseline breast MRI before NAC and follow-up MRI a mean of 3.7 months later. Breast MRI scans were evaluated using the Breast Imaging Reporting and Data System MRI lexicon. In addition, whole-breast vascularity (WBV) in the cancer-bearing breast was graded according to increased vessel number in comparison with the contralateral breast. Histopathologic tumor regression was graded semiquantitatively based on the Miller-Payne grading system. The ability of each MRI feature to predict the response was evaluated using a logistic regression analysis. Correlations between changes in MRI features and response were also evaluated using the Spearman rank correlation test.
There were 73 responders (68%), including 59 partial and 14 complete responders. No significant difference in baseline MRI features was found between the responders and nonresponders, except for tumor size (P = 0.044). No dynamic enhancement feature on baseline MRI was useful for the early prediction of a response. In addition, an increased WBV did not predict a response, and the WBV change on the follow-up MRI was not correlated with the response. However, the change in the initial enhancement pattern (P = 0.007) and kinetic curve type (P = 0.003) were significantly correlated with response.
No baseline MRI feature described using the Breast Imaging Reporting and Data System MRI lexicon was useful for early prediction of the response to NAC.
No preview · Article · May 2013 · Journal of computer assisted tomography
[Show abstract][Hide abstract] ABSTRACT: Purpose:
We assessed the accuracy of coronary computed tomography angiography (CTA) in patients with an Agatston calcium score (ACS) of greater than 400 by comparing it with invasive coronary angiography (ICA), and we evaluated the predictive value of CTA for obstructive coronary heart disease (CHD) compared with traditional clinical risk assessment.
A total of 253 patients who had an ACS of greater than 400 were enrolled in this study. The degree of coronary stenosis was visually and quantitatively estimated by postprocessing imaging using 15-segment coronary models. All patients underwent ICA after a mean (SD) of 34 (24) days, and the degree of coronary stenosis was compared with the results of CTA.
Computed tomography angiography accurately diagnosed significant stenosis in 204 (99.0%) of 206 patients and in 649 (83.5%) of 777 segments. When the patients were considered based on their ACS (group A, 400 < ACS ≤ 1000, vs group B, ACS > 1000), group B showed lower specificity (9.1% vs 41.7%) and poorer agreement (k = 0.149 vs 0.495) than for ICA. By segment-based analysis, the agreement between CTA and ICA was good (k = 0.729), and there was no significant difference between groups A (k = 0.728) and B (k = 0.727). Computed tomography angiography was the most powerful predictor (odds ratio = 52.645, P < 0.001), whereas the 10-year CHD risk and pretest probability were not significantly correlated with obstructive CHD.
Despite good overall diagnostic accuracy, coronary CTA in this group of patients was limited by low specificity. However, CTA was a better predictor of obstructive CHD compared with clinical predictors, and it avoided unnecessary ICA, even in patients with extensive coronary artery calcification.
No preview · Article · May 2013 · Journal of computer assisted tomography
[Show abstract][Hide abstract] ABSTRACT: Granulocytic sarcoma is a localized extramedullary solid tumor composed of immature myeloid cell and is usually associated with acute myeloid leukemia or myelodysplastic syndrome. Although it can involve any site, commonly in lymph nodes, skin, bone and soft tissue, the involvement of breast is unusual. Especially, the involvement of the breast as a pattern of relapse after bone marrow transplantation is extremely rare. We have experienced 2 cases of granulocytic sarcoma after bone marrow transplantation. One case was a 39-year-old woman with right breast mass diagnosed with granulocytic sarcoma. She had received an unrelated bone marrow transplantation due to biphenotype acute leukemia 3 years before our presentation. Another case was a 48-year-old woman with acute myeloid leukemia, who was diagnosed with granulocytic sarcoma on both breasts 8 months after allogenic bone marrow transplantation. We also discuss the clinicopathologic features of granulocytic sarcoma in breast after bone marrow transplantation.
Full-text · Article · Mar 2013 · Journal of Breast Cancer