Rachel F. Brem

Diffusion imaging of human breast

It is shown that diffusion‐weighted imaging is possible in the human breast. Diffusion constants were measured in the breast parenchyma of four volunteers with no known breast lesions. The apparent diffusion constant of water measured in regions of interest chosen in normal human breast fibroglandular tissue was 1.64±0.19×10−5u2009cm2/s and that measured in the area of fatty breast tissue was 0.32±0.18×10−5u2009cm2/s. The resulting images indicate that fibroglandular tissue and fat can be clearly distinguished in diffusion‐weighted as well as in absolute diffusion images of the breast. Potential future applications of this technology for the study of breast pathologies are suggested.

Breast-Specific Gamma Imaging with 99mTc-Sestamibi and Magnetic Resonance Imaging in the Diagnosis of Breast Cancer—A Comparative Study

Abstract:u2002 The purpose of this study was to compare the sensitivity and specificity of breast‐specific gamma imaging (BSGI) using a high‐resolution breast‐specific gamma camera and magnetic resonance imaging (MRI) in patients with indeterminate breast findings. Twenty‐three women with an indeterminate breast finding that required BSGI and MRI as deemed necessary by the interpreting radiologist or referring physician were included. MRI was performed on a GE 1.5T scanner and BSGI was performed on a Dilon high‐resolution breast‐specific gamma camera. All imaging findings were correlated with pathologic diagnosis. Thirty‐three indeterminate lesions were evaluated in the study. There were a total of nine pathologically confirmed cancers. There was no statistically significant difference in sensitivity of cancer detection between BSGI and MRI. BSGI demonstrated a greater specificity than MRI, 71% and 25%, respectively. BSGI has equal sensitivity and greater specificity than MRI for the detection of breast cancer.

Development of Malignant Breast Microcalcifications after Neoadjuvant Chemotherapy in Advanced Breast Cancer

Abstract: u2002 The increased interest in the use of neoadjuvant chemotherapy for patients with locally advanced or large tumors at initial presentation necessitates the recognition of sequelae of this therapy. This article describes the interval appearance of malignant, linear‐branching, microcalcifications during neoadjuvant chemotherapy for locally advanced breast cancer. Mammographically the malignant microcalcifications appeared only in the region of the breast where the primary tumor was found. Pathologically only a subpopulation of malignant cells responded to the chemotherapy, demonstrating viability of the majority of the tumor, with cell death only in the subpopulation. With the increased use of neoadjuvant chemotherapy, it is important to recognize previously undescribed mammographic findings secondary to this therapeutic approach.u2002

Nonvisualization of a sentinel lymph node on lymphoscintigraphy requiring reinjection of sulfur colloid in a patient with breast cancer.

Purpose: The injection techniques and use of lymphoscintigraphy for sentinel lymph node (SLN) biopsy in breast cancer patients vary. Some do not advocate routine use of lymphoscintigraphy. The purpose of this case report is to illustrate when lymphoscintigraphy should be used. Methods: At our institution, we use periareolar intradermal injections of 0.6 mCi Tc-99m sulfur colloid followed by lymphoscintigraphy with reported identification rates greater than 99%. The only patient in our series who did not have a SLN identified had presented after excisional biopsy of an upper outer quadrant cancer. We report the case of another patient who presented after excision of an upper outer quadrant invasive ductal carcinoma and had no evidence of lymphatic drainage on lymphoscintigraphy after the periareolar injections of radioisotope. Results: Additional injections of 0.4 mCi Tc-99m sulfur colloid were performed lateral to the incision in the upper outer quadrant. On lymphoscintigraphy a SLN was visualized and was subsequently successfully identified intraoperatively. Conclusion: This case report supports the value of lymphoscintigraphy for successful identification of a SLN in a patient with prior surgery. We therefore recommend imaging patients who have had prior breast surgery, particularly excisions in the upper outer quadrant.

Supplemental Views for Equivocal Mammographic Findings: A Pictorial Essay.

dal and mediolateral oblique views. In addition, diagnostic mammography performed for symptomatic patients do not demonstrate 5–20% of cancers (2). Supplemental views result in increased mammographic sensitivity and specificity (3,4). The use of additional views allows further characterization of equivocal mammographic findings. This is a result of dissipation of pseudolesions created by overlapping structures, improved lesion analysis, and increasing accuracy and confidence in the interpretation of mammographic abnormalities. The use of additional views may result in fewer biopsies of benign lesions and in earlier detection of malignant lesions by demonstrating characteristically benign and malignant signs that may not be visible on routine views (3).

Preoperative Needle Localization of Nonpalpable Breast Lesions: Determination of Appropriate Needle Length

▪u2002Abstract: Determination of needle length for needle localization of nonpalpable breast lesions prior to surgical excision biopsy may occasionally be problematic. A method for more accurate needle length determination is presented for use when uncertainty arises. This method was evaluated in 46 consecutive lesions targeted for excision biopsy following mammographically guided needle localization.u2002▪

Abstract 3062: miR-671-5p promotes epithelial-to-mesenchymal transition by downregulating FOXM1 expression in breast cancer

microRNA (miRNA) dysfunction is associated with a variety of human diseases including cancer. Our previous study showed that miR-671-5p was deregulated during breast cancer progression. We aim to decipher the functional mechanism of miR-671-5p in breast cancer. We found that expression of miR-671-5p was decreased significantly in ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) compared to normal and atypical ductal hyperplasia (ADH) in the microdissected formalin-fixed, paraffin-embedded (FFPE) tissues. Forkhead Box M1 (FOXM1), as an oncogenic transcription factor, was predicted as one of the direct targets of miR-671-5p, which was subsequently confirmed by luciferase assays. Forced expression of miR-671-5p in breast cancer cell lines downregulated FOXM1 expression, and attenuated the proliferation and invasion in breast cancer cell lines. Notably, overexpression of miR-671-5p resulted in a shift from epithelial-to-mesenchymal transition (EMT) to mesenchymal-to-epithelial transition (MET) phenotypes in MDA-MB-231 breast cancer cells and induced S-phase arrest. Moreover, miR-671-5p sensitized breast cancer cells to cisplatin, 5-fluorouracil (5-FU) and epirubicin exposure. Host cell reactivation (HCR) assays showed that miR-671-5p reduces DNA repair capability in post-drug exposed breast cancer cells. These data indicates that miR-671-5p functions as a tumor suppressor miRNA by directly targeting FOXM1 in breast cancer. Hence, miR-671-5p may serve as a novel therapeutic target for breast cancer management. Citation Format: Xiaohui Tan, Yebo Fu, Liang Chen, Shejuan An, Woojin Lee, Yinglei Lai, Katayoon Rezaei, Sana Tabbara, Christine B. Teal, Yan-gao Man, Robert Siegel, Rachel F. Brem, Sidney W. Fu. miR-671-5p promotes epithelial-to-mesenchymal transition by downregulating FOXM1 expression in breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3062. doi:10.1158/1538-7445.AM2015-3062

Minimally invasive breast biopsy: the breast imager's perspective

Since the initial implementation of film-screen mammography in the 1970s as a screening exam for breast cancer, breast imaging has evolved by leaps and bounds. Today’s breast imager utilizes multiple imaging modalities including full-field digital mammography (FFDM), ultrasound (US), and magnetic resonance imaging (MRI), and more recently, molecular imaging techniques including breastspecific gamma imaging (BSGI) and positron emission mammography (PEM) to aid in the evaluation of breast pathology. With these advances came the ability to diagnose smaller, non-palpable, and earlier-stage breast cancers. This carries with it the challenge of developing imageguided methods to provide a pathologic diagnosis in an accurate, cost-effective, and safe manner. The subsequent development of multi-modality techniques for minimally invasive, image-guided breast biopsy has largely occurred to help solve this diagnostic challenge. The initial techniques for obtaining pathologic diagnoses of non-palpable, radiologic lesions included more invasive open surgical techniques, such as blind quadrantectomy or segmentomy. However, high rates of reexcision were reported. Therefore, the next development was preoperative internal needle and wire localization techniques, utilizing mammographic guidance. Wire-guided surgical breast biopsy was, until recently, the “gold standard” for the diagnosis of non-palpable radiographically detected breast lesions. However, this technique continued to be fraught with pitfalls, including inexact wire placement, dislodgement or fracture of placed wires, and a recovery rate of the radiographic abnormality anywhere from 2% to 20%. However, one of the most consistent trends in medicine has been the steady strive to develop technology that allows physicians to accurately and safely diagnose and treat patients via ever less invasive methods. Breast imaging and intervention has undergone great changes over the past several decades, due to the development of image-guided minimally invasive technologies. These techniques are now available utilizing all traditional forms of breast imaging, including mammographic (stereotactic), US, MRI and most recently, nuclear medicine guidance to include BSGI and PEM.