Jane Wang

Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study

BackgroundThe study was conducted to investigate the diagnostic performance of infrared (IR) imaging of the breast using an interpretive model derived from a scoring system.MethodsThe study was approved by the Institutional Review Board of our hospital. A total of 276 women (mean age = 50.8 years, SD 11.8) with suspicious findings on mammograms or ultrasound received IR imaging of the breast before excisional biopsy. The interpreting radiologists scored the lesions using a scoring system that combines five IR signs. The ROC (receiver operating characteristic) curve and AUC (area under the ROC curve) were analyzed by the univariate logistic regression model for each IR sign and an age-adjusted multivariate logistic regression model including 5 IR signs. The cut-off values and corresponding sensitivity, specificity, Youdens Index (Index = sensitivity+specificity-1), positive predictive value (PPV), negative predictive value (NPV) were estimated from the age-adjusted multivariate model. The most optimal cut-off value was determined by the one with highest Youdens Index.ResultsFor the univariate model, the AUC of the ROC curve from five IR signs ranged from 0.557 to 0.701, and the AUC of the ROC from the age-adjusted multivariate model was 0.828. From the ROC derived from the multivariate model, the sensitivity of the most optimal cut-off value would be 72.4% with the corresponding specificity 76.6% (Youdens Index = 0.49), PPV 81.3% and NPV 66.4%.ConclusionsWe established an interpretive age-adjusted multivariate model for IR imaging of the breast. The cut-off values and the corresponding sensitivity and specificity can be inferred from the model in a subpopulation for diagnostic purpose.Trial RegistrationNCT00166998.

The evaluation of false negative mammography from malignant and benign breast lesions

Preoperative mammograms from 395 breast cancers and 132 benign breast lesions were enrolled for this study. The false-negative (FN) rate for breast cancers from preoperative reading was 9.6% with 38 breast cancers missed on mammograms. The statistically significant differences occurred between true-positive (TP) and FN cancers for younger age (P<.025), smaller lesion size (P<.001), denser breast (P<.05), deep retroglandular location (P<.001). None of the FN cancers exhibited calcifications. The FN rate for mammography for benign breast lesions from preoperative reading was 18.9% with 25 lesions misdiagnosed. The statistically significant difference between benign TP and FN lesions occurred for central and subareolar location (P<.025). Exploration of possible factors and imaging features in FN mammograms can help reduce the FN rate for mammography.

Silicone migration from silicone-injected breasts: magnetic resonance images.

Injection of liquid silicone into the breast was performed illicitly in the 1950s to 1960s and was subsequently prohibited. Many complications arise from silicone injection, and liquid silicone migration is a complication that has not been widely reported. The authors present magnetic resonance images of a patient with liquid silicone migration from the breast to the upper chest and lower neck. Breast ultrasonographic and mammographic findings are also presented for correlation.

Lymphangioleiomyomatosis initially presenting with abdominal pain: A case report

Lymphangioleiomyomatosis (LAM) is a rare idiopathic disease characterized by hamartomatous smooth muscle proliferation of the lymph node, lymphatics, blood vessels as well as airways within the lungs, mediastinum and abdomen. It exclusively affects women during the reproductive period. Though extrapulmonary manifestations have been reported, the initial presentation of LAM as abdominal pain is extremely rare. To our knowledge, there are only three cases with LAM presenting first with abdominal symptoms so far [Chest 106 (1994) 267; Eur J Radiol 14 (1992) 192; Eur J Surg 157 (1991) 36]. We describe a case of LAM suffering from abdominal pain followed by pulmonary symptoms and the diagnosis was not made until pathohistological examination.

Efficacy of mammographic evaluation of breast cancer in women less than 40 years of age: experience from a single medical center in Taiwan.

BACKGROUND/PURPOSE Mammography is the standard imaging modality for breast cancer diagnosis. However, the value of mammographic diagnosis in breast cancer patients aged less than 40 years old has not been well assessed. The goal of our study was to determine the diagnostic efficacy of mammography for the detection of breast cancer in women under 40 years of age in a single medical center in Taiwan. METHODS Of 1766 women diagnosed with breast cancer in one medical center between 1999 and 2005, 227 (12.9%) who were younger than 40 years of age were enrolled, and 105 of these 227 patients had pre-biopsy mammograms available for analysis. The sensitivities for mammography at first (prospective) and second (retrospective) readings and for corresponding ultrasound were calculated. The distribution of different breast composition between the mammographic true-positive (TP) and false-negative (FN) lesions at the first and second readings was analyzed. RESULTS Of the 105 patients, 104 presented with a palpable mass and the other one was asymptomatic. There were 109 pathologically proven breast cancers from the 105 patients; 92 of 109 cancerous lesions were detected at the first mammographic reading (sensitivity 84.4%), and the most common mammographic sign was microcalcifications (40.2%). The second reading detected seven additional cancers (99 of 109 lesions; sensitivity 90.8%). There was no significant difference between mammographic TP and FN lesions for the different breast composition on first and second readings. Ninety patients also had ultrasound available for correlation with 94 cancers diagnosed from them. The diagnostic sensitivity of ultrasound was 94.7% (89 of 94 lesions). CONCLUSION Mammography has an acceptable sensitivity for the detection of breast cancer in women aged less than 40 years, regardless of different breast composition. Breast ultrasound can offer a higher sensitivity for such a population.

Vascularity Change and Tumor Response to Neoadjuvant Chemotherapy for Advanced Breast Cancer

For advanced breast cancer with severe local disease (ABC) (stage III/IV), neoadjuvant chemotherapy improves local control and surgical outcome. However, about approximately 20 to 30% of advanced cancers show either no or poor response to chemotherapy. To prevent unnecessary treatment, a capability of predicting clinical response to neoadjuvant chemotherapy of ABC is highly desirable. Vascularity index (VI) of breast cancers was derived from the quantification results in 30 ABC patients by using power Doppler sonography. Power Doppler sonography evaluation was performed every one to two weeks during chemotherapy. The overall response rate for 30 advanced patients tested was 70%, when 50% or more reduction in tumor size was the objective clinical response. Chemotherapy response was unrelated to the original tumor size (p = 0.563) or chemotherapy agents used (p = 0.657). The median VI for all 30 patients was 4.99%. The response rates for hypervascular tumors vs. hypovascular tumors, based on initial median value, were 86.7% and 53.3%, respectively (p = 0.109). The average VIs in responders and nonresponders were 7.67 +/- 4.77% and 4.01 +/- 3.82% (p = 0.052). There was a tendency for responders who have a relatively high initial vascularity. The VI change in responder group shows a pattern of initial increasing in vascularity followed by decreasing in vascularity. All patients (17/17) with a VI increment of >5% during chemotherapy had good chemotherapy response, whereas in patients with a VI increment of <5%, the response rate was 30.8% (4/13) (p < 0.001). For patients with a peak VI of >10% during chemotherapy, the response rate was 94.1% (16/17). However, in patients with a peak VI of <10%, the response rate was 38.5% (5/13) (p = 0.001). This prediction was made mostly within one month (25.47 +/- 12.96 d for VI increments >5% and 25.44 +/- 12.41 d for VI increased to >10%). In the meantime, the differences in size reduction shown in B-mode sonography were insignificant between responders and nonresponders (patient group with VI increment >5%, p = 0.308; patient group with peak VI >10%, p = 0.396). In conclusion, we propose that VI as determined by using power Doppler sonography is a good and inexpensive clinical tool for monitoring vascularity changes during neoadjuvant chemotherapy in ABC patients. Two parameters--VI increment >5% and peak VI >10%--are potential early predictors for good responses to neoadjuvant chemotherapy within one month in patients with ABC.

Changes in quality of life and working capacity before and after kidney transplantation

KIDNEY transplantation (KT) has evolved as a successful therapy for patients struggling with end-stage renal disease. Advances in surgical and medical protocols have resulted in the excellent survival rates. 1,2 Debates regarding the quality of life (QOL) of dialysis and transplant recipient groups have been ongoing for about two decades. 3‐11 Although most studies show that QOL is one of the most important benefits of KT, 3,7‐24 some researchers still argue that KT does not significantly improve QOL over dialysis. 4‐6 The health-related QOL of KT recipients is a complex phenomenon. Recipients’ assessment of QOL often reflects their adaptation to their postdischarge, posttransplant lives. During the predischarge stage, most Taiwanese KT recipients are anxious about the quality of medical care, their self-efficacy, and related social support. Alleviating the anxiety of KT recipients with regard to these issues may be critical in determining their recovery and QOL after discharge. 25 However, few researchers have prospectively monitored the monthly changes in the selfrated QOL of KT recipients during the first postdischarge year. Instead, the QOL is often examined from a crosssectional view, according to the time frame of standard posttransplant evaluation visits; these evaluations tend to center around the medium- or long-term survivors. 4 ‐ 6,8 ‐18 Working capacity (WC) as well as income are important indicators of self-assessed QOL among Taiwanese KT recipients. 2 However, the challenge of transplantation to a recipient’s postoperative economic status, and the relationship between recipients’ QOL and WC during the first posttransplant year have not been carefully investigated. The purpose of this study was to examine the trend of changes in the QOL and WC after KT, from the preoperative stage to 1 year after discharge from the hospital after KT. PATIENTS AND METHODOLOGY A descriptive, prospective design was used to explore the trends in QOL and WC perceived by KT recipients before and after surgery. The inclusion criteria were as follows: (1) at least 18 years old; (2) clear consciousness; (3) no transplant surgeries other than KT; and (4) prepared to be discharged from National Taiwan University Hospital the next day. The first interview was conducted 1 day before the patient’s discharge from the hospital, and follow-up interviews were conducted 1, 2, 3, 6, and 12 months after discharge from the hospital during outpatient, posttransplant visits. The patient profile was used to collect information about the patient’s demographic information, medical history, medications that the subjects had taken in the floor unit, postoperative complications, and the length of floor unit stay. The subjects were asked to rate their perceptions of QOL and WC on separate visual analog scales (VASs). The VAS used in this study was a 100-millimeter (mm) vertical line. This line was anchored at the bottom with the words “Worst quality of life” or “Unable to work,” and at the top by “Optimal quality of life” or “Optimal working capacity,” respectively. During the first interview, the participants were also asked to rate their perceptions of overall preoperative QOL and WC on VASs, based on their 24 hours preoperatively.

The Association of Infrared Imaging Findings of the Breast with Hormone Receptor and Human Epidermal Growth Factor Receptor 2 Status of Breast Cancer

RATIONALE AND OBJECTIVES Evidence on breast infrared (IR) imaging and its association with estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) statuses of breast cancers is limited. The aim of this study was to investigate the association of IR imaging findings and ER, PR, and HER2 status in breast cancers. MATERIALS AND METHODS A total of 163 women with 171 pathologically proven breast cancers underwent IR imaging of the breast before surgery. Five IR signs were used to score the lesions: IR1, the temperature difference (ΔT) of the lesion site from that of the contralateral mirror image site; IR2, ΔT of the lesion site from that of the adjacent normal breast tissue in the same breast; IR3, abnormal vascular morphologic patterns; IR4, focal bulge or edge sign with back heat at the lesion site; and IR5, asymmetric thermographic pattern between the lesion site and the contralateral breast. The association of different IR signs with ER, PR, and HER2 status was evaluated using Fishers exact test. RESULTS IR1 was inversely associated with ER (P = .010) and PR status (P = .039). IR2 was inversely related to PR status (P = .020). IR5 was inversely associated with ER (P = .037) and PR (P = .022) status. No IR sign was associated with HER2 status. Triple-negative (ER-negative, PR-negative, and HER2-negative) cancers tended to show higher IR1 scores compared to other types of cancers (P = .029). CONCLUSION Breast IR findings were associated with ER and PR status of breast cancers. Triple-negative cancers more frequently featured higher IR1 scores than other types of cancers.

Proton MR Spectroscopy in Normal Breasts Between Pre- and Postmenopausal Women: A Preliminary Study

OBJECTIVE The purpose of our study was to assess the differences in the water and lipid fractions and lipid line widths in normal breasts between premenopausal and postmenopausal women using single-voxel proton MR spectroscopy (1H-MRS). MATERIALS AND METHODS Thirty-two premenopausal and 25 postmenopausal women were enrolled in the study. Single-voxel proton MR spectroscopy of the breast was performed using point-resolved spectroscopy (PRESS) with water suppression and stimulated echo acquisition mode (STEAM). On STEAM, water fraction 1 was the ratio of the integration of water to the sum of the integration of water and methylene resonances, and the lipid fraction 1 was the ratio of the integration of methylene to water and methylene resonances. Lipid fraction 2 was the ratio of the integration of allylic methylene to water and allylic methylene resonances. Lipid line width was measured on PRESS. RESULTS The premenopausal group had a higher water fraction 1 and lower lipid fraction 1 than the postmenopausal group (p < 0.01, Students t test). The breast density had a positive effect on water fraction 1 and a negative effect on lipid fraction 1 for premenopausal women (p = 0.018, multivariate regression) and for the total population (p = 0.019). The premenopausal women had a higher lipid fraction 2 than postmenopausal women without significance (Students t test), but the premenopausal status had a positive effect on lipid fraction 2 (p = 0.024, multivariate regression). There was no significant correlation between all independent variables and lipid line width. CONCLUSION Breast 1H-MRS shows the differences of water and lipid compositions between pre- and postmenopausal women. Lipids containing methylene and allylic methylene protons had different implications in normal breasts.

Multiparametric Evaluation of Treatment Response to Neoadjuvant Chemotherapy in Breast Cancer Using Integrated PET/MR

Purpose The aim of this study was to investigate whether integrated PET/MR system can predict the treatment response to neoadjuvant chemotherapy (NAC) early in the course of breast cancer treatment. Methods Fourteen women with newly diagnosed invasive breast cancer (median age, 54.5 years) were recruited. Each participant underwent 2 PET/MR studies. Study 1 was pre-NAC; study 2 was early in NAC treatment (after the first or second cycle). PET parameters included SUVmax and total lesion glycolysis (TLG). MRI parameters included choline signal-to-noise ratio (ChoSNR), peak enhancement ratio (PER), and the minimum apparent diffusion coefficient (ADCmin). The pathologic response was categorized as a pathologic complete response or residual cellularity of less than 10% (group 1) and residual cellularity of 10% or greater (group 2). The accuracy of the NAC response prediction was obtained by receiver operating characteristic analysis. Results Group 1 showed a greater reduction of SUVmax (percentage change, [INCREMENT]% SUVmax, P = 0.013; area under the receiver operating characteristic curve [AUC], 0.898), TLG ([INCREMENT]%TLG, P = 0.018; AUC = 0.878), and PER ([INCREMENT]% PER, P = 0.035; AUC = 0.837) than did group 2. The ChoSNR, ADCmin, [INCREMENT]%ChoSNR, and [INCREMENT]%ADCmin did not differ significantly between the 2 groups. The hybrid markers, [INCREMENT]%SUVmax/[INCREMENT]%ADCmin (AUC = 0.976) and [INCREMENT]%TLG/[INCREMENT]%ADCmin (AUC = 0.905), showed greater accuracy in predicting NAC response than the individual PET/MR parameters. Conclusions The PET/MR parameters can predict the NAC response early in the course of breast cancer treatment. The hybrid markers more accurately predicted treatment response than the individual PET/MR parameters.