Bo La Yun

Trastuzumab-Conjugated Liposome-Coated Fluorescent Magnetic Nanoparticles to Target Breast Cancer

Objective To synthesize mesoporous silica-core-shell magnetic nanoparticles (MNPs) encapsulated by liposomes (Lipo [MNP@m-SiO2]) in order to enhance their stability, allow them to be used in any buffer solution, and to produce trastuzumab-conjugated (Lipo[MNP@m-SiO2]-Her2Ab) nanoparticles to be utilized in vitro for the targeting of breast cancer. Materials and Methods The physiochemical characteristics of Lipo[MNP@m-SiO2] were assessed in terms of size, morphological features, and in vitro safety. The multimodal imaging properties of the organic dye incorporated into Lipo[MNP@m-SiO2] were assessed with both in vitro fluorescence and MR imaging. The specific targeting ability of trastuzumab (Her2/neu antibody, Herceptin®)-conjugated Lipo[MNP@m-SiO2] for Her2/neu-positive breast cancer cells was also evaluated with fluorescence and MR imaging. Results We obtained uniformly-sized and evenly distributed Lipo[MNP@m-SiO2] that demonstrated biological stability, while not disrupting cell viability. Her2/neu-positive breast cancer cell targeting by trastuzumab-conjugated Lipo[MNP@m-SiO2] was observed by in vitro fluorescence and MR imaging. Conclusion Trastuzumab-conjugated Lipo[MNP@m-SiO2] is a potential treatment tool for targeted drug delivery in Her2/neu-positive breast cancer.

Sonoelastography in Distinguishing Benign from Malignant Complex Breast Mass and Making the Decision to Biopsy

Objective To evaluate the additional effect of sonoelastography on the radiologists ability for distinguishing benign from malignant complex breast masses and to decide whether to perform biopsy by B-mode US. Materials and Methods One hundred eighteen complex breast masses (15 malignant lesions, 103 benign lesions) were included. Five blinded readers independently assessed the likelihood of the malignancy score from 1 to 5 for two data sets (B-mode ultrasound alone and B-mode ultrasound with sonoelastography). Elasticity scores were categorized as 0, 1, or 2 based on the degree and distribution of strain of the echogenic component within complex masses. The readers were asked to downgrade the likelihood of the malignancy score when an elasticity score of 0 was assigned and to upgrade the likelihood of the malignancy score when an elasticity score of 2 was assigned. The likelihood of the malignancy score was maintained as it was for the lesions with an elasticity score of 1. The Az values, sensitivities, and specificities were compared. Results The Az value of B-mode ultrasound with sonoelastography (mean, 0.863) was greater than that of B-mode ultrasound alone (mean, 0.731; p = 0.001-0.007) for all authors. The specificity of B-mode ultrasound with sonoelastography (mean, 37.1%) was greater than that of B-mode ultrasound alone (mean, 3.8%; p < 0.001) for all readers. The addition of sonoelastography led to changes in decisions. A mean of 33.6% of benign masses were recommended for follow-up instead of biopsy. Conclusion For complex breast masses, sonoelastography allows increase in both the accuracy in distinguishing benign from malignant lesions and the specificity in deciding whether to perform biopsy.

The Management Strategy of Benign Solitary Intraductal Papilloma on Breast Core Biopsy

Background Intraductal papilloma (IDP) is well‐known as one of the common benign breast lesions requiring excision. However, treatment of IDP without atypia is controversial. The aim of our study was to determine the proper management of solitary IDP by core needle biopsy (CNB). Patients and Methods We retrospectively reviewed patients with solitary IDP confirmed by CNB from March 2003 to March 2015. We collected data about final pathology after excision, as well as clinical, histologic, and radiologic findings at initial diagnosis. The final pathology was categorized as benign or malignant. We evaluated the rate of upgrade to malignancy and factors associated with malignancy. Results We identified 405 patients who presented benign solitary IDP by CNB. The mean age was 46.1 years (range, 15‐86 years). In total, 135 patients underwent surgical excision, and 211 underwent vacuum‐assisted excision. Of 346 patients, malignant lesions were found in 8 patients (2.3%): 7 underwent surgical excision, and 1 underwent vacuum‐assisted excision. Only the size of IDP was significantly associated with cancer upgrade (P = .003). Conclusions Our study shows that overall malignancy upgrade rate of benign solitary IDP after excision is very low (2.3%). Even when the size of IDP was less than 1 cm, the upgrade rate to cancer was only 0.9%. Therefore, for patients with small solitary IDP, we recommend close follow‐up with ultrasound instead of excision. Micro‐Abstract We evaluated cancer upgrade rate of intraductal papilloma (IDP) without atypia after excision for 346 patients. Overall upgrade rate was 2.3%. Mass size was the only predictor for cancer. Higher upgrade rate was observed in patients with a larger mass (> 2 cm: 15.8%, 1‐2 cm: 3.0%, and ≤ 1 cm: 0.9%). Our study suggested that small (≤ 1 cm) IDP without atypia could be followed‐up.

Does Adding Diffuse Optical Tomography to Sonography Improve Differentiation Between Benign and Malignant Breast Lesions? Observer Performance Study

The purpose of this study was to investigate the added value of diffuse optical tomographic categories combined with conventional sonography for differentiating between benign and malignant breast lesions.

Reproducibility of Apparent Diffusion Coefficient Measurements in Malignant Breast Masses

This study aimed to evaluate the reproducibility of apparent diffusion coefficient (ADC) measurements in malignant breast masses, and to determine the influence of mammographic parenchymal density on this reproducibility. Sixty-six patients with magnetic resonance findings of the mass were included. Two breast radiologists measured the ADC of the malignant breast mass and the same area on the contralateral normal breast in each patient twice. The effects of mammographic parenchymal density, histology, and lesion size on reproducibility were also assessed. There was no significant difference in the mean ADC between repeated measurements in malignant breast masses and normal breast tissue. The overall reproducibility of ADC measurements was good in both. The 95% limits of agreement for repeated ADCs were approximately 30.2%-33.4% of the mean. ADC measurements in malignant breast masses were highly reproducible irrespective of mass size, histologic subtype, or coexistence of microcalcifications; however, the measurements tended to be less reproducible in malignant breast masses with extremely dense parenchymal backgrounds. ADC measurements in malignant breast masses are highly reproducible; however, mammographic parenchymal density can potentially influence this reproducibility.

Quantitative analysis of breast parenchymal background enhancement (BPE) on magnetic resonance (MR) imaging: Association with mammographic breast density and aggressiveness of the primary cancer in postmenopausal women.

38 Background: To evaluate semiautomated quantitative analysis of the BPE in postmenopausal women who were diagnosed breast cancer and to correlate it with mammographic breast density and aggressiveness of the primary cancer. METHODS Informed patient consent was waived after institutional review board approved this study. Four hundred eighty two breast cancer patients performed breast MRI in our institution during 16 months, and 84 postmenopausal women of them were included in this study (median age, 67.2 years; range, 60-76 years). Ordinary values of BPE and breast density were described by an experienced breast radiologist using the BIRADS lexicon. The BPE was calculated with semiautomated quantitative method for quantitative analysis: BPE coefficient (BEC = SI1-SI0 / S0 × 100), where SI is signal intensity, SI1 is the SI enhancement measured in the largest dimension of the sagittal plane at the first postcontrast image, and S0 is the SI before contrast injection. On surgical pathology, pathologic subtype, nuclear and histologic grade, estrogen receptor (ER), progesterone receptor (PR), HER2≠neu, venous and lymphatic invasion, lymph node metastasis was evaluated. And then, the mean BEC of the patients who diagnosed local or systemic recurrence on follow-up was calculated and compared with that of the patients without recurrence. The statistical analysis was performed using Kruskal-Wallis test and Mann-Whitney U test. RESULTS The mean BEC of the postmenopausal women was 3.96 ± 6.71 in right breast and 3.41 ± 8.09 in left breast. There was no significant difference in the BEC between mammographic breast density groups (P > 0.05). There was no significant correlation between BPE and aggressiveness of the primary breast cancer. However, the mean BEC was higher in the recurrent patient group (n = 6, mean=16.23 ± 19.88) compared with the patients without recurrence (n = 78, mean=2.44 ± 5.62). CONCLUSIONS No association was found between BPE and aggressiveness of the primary breast cancer, BPE and breast density. However, the mean BEC was higher in the patients who diagnosed local or systemic recurrence.

Comparison of the Diagnostic Performance of Synthetic Versus Acquired High b-Value (1500 s/mm2) Diffusion-Weighted MRI in Women With Breast Cancers: Synthetic High b DWI in Breast Cancer

Acquired high b‐value (>1000 s/mm2) diffusion‐weighted imaging (DWI) has its strength in lesion detection. However, it is not easily used, due to a lower signal‐to‐noise ratio, eddy current distortions, and prolonged acquisition times. Synthetic DWI does not have these disadvantages because it is based on indirect acquisition, calculated in a voxel‐wise manner.

Comparison of ultrasound with ultrasound-guided fine-needle aspiration biopsy and core needle biopsy for initial axillary staging of breast cancer patients.

96 Background: The sensitivity and specificity of FNAB and CNB performed in suspicious axillary LNs have ranged from 56% to 86% and from 91% to 100%, because FNAB and CNB are operator- and institution-dependent procedures. In addition, previous studies concerning the diagnostic accuracy of these procedures have reported results from only FNAB or CNB. So, the purpose of this study was to determine the diagnostic accuracy of axillary US and compare that of US-guided FNAB with CNB for axillary staging in the same breast cancer population. METHODS Of 220 breast cancer patients who underwent preoperative or prechemotherapy axillary US for axillary staging, 52 patients who underwent US-guided FNAB and CNB of cortical thickening and/or compressed hilum of lymph nodes on US were prospectively enrolled. US and FNAB/CNB findings were compared with final pathology from sentinel lymph node biopsy or axillary lymph node dissection. RESULTS Forty-eight patients met the final study criteria; we excluded 4 who had received primary systemic chemotherapy and showed negative FNAB/CNB results with negative final post-operative pathology. Positive predictive value (PPV) of axillary US was 54%. The sensitivity and specificity of FNAB were 73% and 100%, and those of CNB were 77% and 100%. Results did not significantly differ between US-guided CNB and FNAB. The complication rates of FNAB and CNB were 4%, and FNAB and CNB cost

Comparison of strain and shear wave elastography for qualitative and quantitative assessment of breast masses in the same population

180 and

Predictors of Invasive Breast Cancer in Patients With Ductal Carcinoma In Situ in Ultrasound-Guided Core Needle Biopsy: Invasive Cancer Predictors in Core Needle Breast Biopsy

350, respectively. CONCLUSIONS Both US-guided CNB and FNAB were useful for axillary staging in breast cancer patients with high sensitivity. However, FNAB is recommended based on the advantages of low cost and minimal invasiveness.