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Tea seed oil is a popular cooking oil in Chinese traditional culture, but its high cost makes it a target for adulteration. This study presents a novel method for detecting seed adulteration of tea seed oil in Taiwan using chloroplast simple sequence repeat (cpSSR) markers. The complete chloroplast genome of Camellia oleifera was analyzed, and two cpSSR markers were designed that show polymorphism between C. oleifera and C. brevistyla. The study found identical genotypes between self-sibs and their mother tree in C. brevistyla, demonstrating stability of maternal inheritance. Two cpSSRs could be used for genotyping at each step of oil-making procedure; the best checkpoint is before crude oil. Two cpSSR markers could be used for identification of two Taiwan local tea-seed oil from imported seeds and be potential for tea-seed oil certification and adulteration detection in the future. [ABSTRACT FROM AUTHOR]

Purpose: To develop a prediction model incorporating clinicopathological information, US, and MRI to diagnose axillary lymph node (LN) metastasis with acceptable false negative rate (FNR) in patients with early stage, clinically node-negative breast cancers. Methods: In this single center retrospective study, the inclusion criteria comprised women with clinical T1 or T2 and N0 breast cancers who underwent preoperative US and MRI between January 2017 and July 2018. Patients were temporally divided into the development and validation cohorts. Clinicopathological information, US, and MRI findings were collected. Two prediction models (US model and combined US and MRI model) were created using logistic regression analysis from the development cohort. FNRs of the two models were compared using the McNemar test. Results: A total of 964 women comprised the development (603 women, 54 ± 11 years) and validation (361 women, 53 ± 10 years) cohorts with 107 (18%) and 77 (21%) axillary LN metastases in each cohort, respectively. The US model consisted of tumor size and morphology of LN on US. The combined US and MRI model consisted of asymmetry of LN number, long diameter of LN, tumor type, and multiplicity of breast cancers on MRI, in addition to tumor size and morphology of LN on US. The combined model showed significantly lower FNR than the US model in both development (5% vs. 32%, P <.001) and validation (9% vs. 35%, P <.001) cohorts. Conclusion: Our prediction model combining US and MRI characteristics of index cancer and LN lowered FNR compared to using US alone, and could potentially lead to avoid unnecessary SLNB in early stage, clinically node-negative breast cancers. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the combined use of blood-based 3-protein signature and breast ultrasound (US) for validating US-detected lesions. Methods: From July 2011 to April 2020, women who underwent whole-breast US within at least 6 months from sampling period were retrospectively included. Blood-based 3-protein signature (Mastocheck®) value and US findings were evaluated. Following outcome measures were compared between US alone and the combination of Mastocheck® value with US: sensitivity, specificity, positive predictive value (PPV), negative predictive value, area under the receiver operating characteristic curve (AUC), and biopsy rate. Results: Among the 237 women included, 59 (24.9%) were healthy individuals and 178 (75.1%) cancer patients. Mean size of cancers was 1.2 ± 0.8 cm. Median value of Mastocheck® was significantly different between nonmalignant (− 0.24, interquartile range [IQR] − 0.48, − 0.03) and malignant lesions (0.55, IQR − 0.03, 1.42) (P <.001). Utilizing Mastocheck® value with US increased the AUC from 0.67 (95% confidence interval [CI] 0.61, 0.73) to 0.81 (95% CI 0.75, 0.88; P <.001), and specificity from 35.6 (95% CI 23.4, 47.8) to 64.4% (95% CI 52.2, 76.6; P <.001) without loss in sensitivity. PPV was increased from 82.2 (95% CI 77.1, 87.3) to 89.3% (95% CI 85.0, 93.6; P <.001), and biopsy rate was significantly decreased from 79.3 (188/237) to 72.1% (171/237) (P <.001). Consistent improvements in specificity, PPV, and AUC were observed in asymptomatic women, in women with dense breast, and in those with normal/benign mammographic findings. Conclusion: Mastocheck® is an effective tool that can be used with US to improve diagnostic specificity and reduce false-positive findings and unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Objectives: To prospectively evaluate the diagnostic performance of screening ABUS as the primary screening test for breast cancer among Korean women aged 40–49 years. Methods: This prospective, multicenter study included asymptomatic Korean women aged 40–49 years from three academic centers between February 2017 and October 2019. Each participant underwent ABUS without mammography, and the ABUS images were interpreted at each hospital with double-reading by two breast radiologists. Biopsy and at least 1 year of follow-up was considered the reference standard. Diagnostic performance of ABUS screening and subgroup analyses according to patient and tumor characteristics were evaluated. Results: Reference standard data were available for 959 women. The recall rate was 9.8% (95% confidence interval [CI]: 7.9%, 11.7%; 94 of 959 women) and the cancer detection yield was 5.2 per 1000 women (95% CI: −0.6, 11.1; 5 of 959 women). There was only one interval cancer. The sensitivity was 83.3% (95% CI: 53.5%, 100%; 5 of 6 cancers) and the specificity was 90.7% (95% CI: 88.8%, 92.5%; 864 of 95. women). The positive predictive values of biopsies performed (PPV3) was 20.0% (95% CI: 4.3%, 35.7%; 5 of 25 women). Women with heterogeneous background echotexture had a higher recall rate (p =.009) and lower specificity (p =.036). Women with body mass index values < 25 kg/m2 had a higher mean recall rate (p =.046). Conclusion: In East Asia, screening automated breast US may be an alternative to screening mammography for detecting breast cancers in women aged 40–49 years. Key Points: • Automated breast US screening for breast cancer in asymptomatic women aged 40–49 is effective with 5.2 per 1000 cancer detection yield. • Women with heterogeneous background echotexture had a higher recall rate and lower specificity. • Women with body mass index < 25 kg/m2had a higher recall rate. [ABSTRACT FROM AUTHOR]

Purpose: To investigate clinical and imaging features associated with a high nodal burden (≥ 3 metastatic lymph nodes [LNs]) and compare diagnostic performance of US and MRI in patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Methods: Retrospective search revealed 239 patients with ILC and 999 with IDC who underwent preoperative US and MRI between January 2016 and June 2019. Patients with ILC were propensity-score-matched with patients with IDC. Univariate and multivariate logistic regression analyses were performed to determine factors associated with ≥ 3 metastatic LNs. Results: 412 patients (206 ILC and 206 IDC) were evaluated. Of all patients with ILC, 27.2% (56/206) were node-positive and 7.8% (16/206) showed a high nodal burden. In multivariate analysis, the clinical N stage was the only independent factor associated with a high nodal burden in patients with IDC (odds ratio [OR] 6.24; 95% confidence interval [CI] 1.57–24.73; P = 0.009), but not in patients with ILC. Increased cortical thickness with loss of fatty hilum on US was associated with a high nodal burden in patients with ILC (OR 58.40; 95% CI 5.09–669.71; P = 0.001) and IDC (OR 24.14; 95% CI 3.52–165.37; P = 0.001), while suspicious LN findings at MRI were independently associated with a high nodal burden in ILC only (OR 13.94; 95% CI 2.61–74.39; P = 0.002). Conclusion: In patients with ILC, MRI findings of suspicious LNs were helpful to predict a high nodal disease burden. [ABSTRACT FROM AUTHOR]

A major limitation of screening breast ultrasound (US) is a substantial number of false-positive biopsy. This study aimed to develop a deep learning-based computer-aided diagnosis (DL-CAD)-based diagnostic model to improve the differential diagnosis of screening US-detected breast masses and reduce false-positive diagnoses. In this multicenter retrospective study, a diagnostic model was developed based on US images combined with information obtained from the DL-CAD software for patients with breast masses detected using screening US; the data were obtained from two hospitals (development set: 299 imaging studies in 2015). Quantitative morphologic features were obtained from the DL-CAD software, and the clinical findings were collected. Multivariable logistic regression analysis was performed to establish a DL-CAD-based nomogram, and the model was externally validated using data collected from 164 imaging studies conducted between 2018 and 2019 at another hospital. Among the quantitative morphologic features extracted from DL-CAD, a higher irregular shape score (P =.018) and lower parallel orientation score (P =.007) were associated with malignancy. The nomogram incorporating the DL-CAD-based quantitative features, radiologists' Breast Imaging Reporting and Data Systems (BI-RADS) final assessment (P =.014), and patient age (P <.001) exhibited good discrimination in both the development and validation cohorts (area under the receiver operating characteristic curve, 0.89 and 0.87). Compared with the radiologists' BI-RADS final assessment, the DL-CAD-based nomogram lowered the false-positive rate (68% vs. 31%, P <.001 in the development cohort; 97% vs. 45% P <.001 in the validation cohort) without affecting the sensitivity (98% vs. 93%, P =.317 in the development cohort; each 100% in the validation cohort). In conclusion, the proposed model showed good performance for differentiating screening US-detected breast masses, thus demonstrating a potential to reduce unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Purpose: Diffusion-weighted magnetic resonance imaging (DW-MRI) offers unenhanced method to detect breast cancer without cost and safety concerns associated with dynamic contrast-enhanced (DCE) MRI. Our purpose was to evaluate the performance of DW-MRI at 3.0T in detection of clinically and mammographically occult contralateral breast cancer in patients with unilateral breast cancer. Methods: Between 2017 and 2018, 1130 patients (mean age 53.3 years; range 26–84 years) with newly diagnosed unilateral breast cancer who underwent breast MRI and had no abnormalities on clinical and mammographic examinations of contralateral breast were included. Three experienced radiologists independently reviewed DW-MRI (b = 0 and 1000 s/mm2) and DCE-MRI and assigned a BI-RADS category. Using histopathology or 1-year clinical follow-up, performance measures of DW-MRI were compared with DCE-MRI. Results: A total of 21 (1.9%, 21/1130) cancers were identified (12 ductal carcinoma in situ and 9 invasive ductal carcinoma; mean invasive tumor size, 8.0 mm) in the contralateral breast. Cancer detection rate of DW-MRI was 13–15 with mean of 14 per 1000 examinations (95% confidence interval [CI] 9–23 per 1000 examinations), which was lower than that of DCE-MRI (18–19 with mean of 18 per 1000 examinations, P = 0.01). A lower abnormal interpretation rate (14.0% versus 17.0%, respectively, P < 0.001) with higher specificity (87.3% versus 84.6%, respectively, P < 0.001) but lower sensitivity (77.8% versus 96.8%, respectively, P < 0.001) was noted for DW-MRI compared to DCE-MRI. Conclusions: DW-MRI at 3.0T has the potential as a cost-effective tool for evaluation of contralateral breast in women with newly diagnosed breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: Accurate prediction of pathologic complete response (pCR) in breast cancer using magnetic resonance imaging (MRI) and ultrasound (US)-guided biopsy may aid in selecting patients who forego surgery for breast cancer. We evaluated the accuracy of US-guided biopsy aided by MRI in predicting pCR in the breast after neoadjuvant chemotherapy (NAC). Methods: After completion of NAC, 40 patients with near pCR (either tumor size ≤ 0.5 cm or lesion-to-background signal enhancement ratio (L-to-B SER) ≤ 1.6 on MRI) and no diffused residual microcalcifications were prospectively enrolled at a single institution. US-guided multiple core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) of the tumor bed, followed by standard surgical excision, was performed. Matched biopsy and surgical specimens were compared to assess pCR. The negative predictive value (NPV), accuracy, and false-negative rate (FNR) were analyzed. Results: pCR was confirmed in 27 (67.5%) surgical specimens. Preoperative biopsy had an NPV, accuracy, and FNR of 87.1%, 90.0%, and 30.8%, respectively. NPV for hormone receptor-negative and hormone receptor-positive tumors were 83.3% and 100%, respectively. Obtaining at least 5 biopsy cores based on tumor size ≤ 0.5 cm and an L-to-B SER of ≤ 1.6 on MRI (27 patients) resulted in 100% NPV and accuracy. No differences in accuracy were noted between CNB and VAB (90% vs. 90%). Conclusions: Investigation using stringent MRI criteria and ultrasound-guided biopsy could accurately predict patients with pCR after NAC. A larger prospective clinical trial evaluating the clinical safety of breast surgery omission after NAC in selected patients will be conducted based on these findings. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted in order to investigate whether there is a correlation between the time-to-enhancement (TTE) in ultrafast MRI and histopathological characteristics of breast cancers.Methods: Between January and August 2017, 274 consecutive breast cancer patients (mean age, 53.5 years; range, 25-80 years) who underwent ultrafast MRI and subsequent surgery were included for analysis. Ultrafast MRI scans were acquired using TWIST-VIBE or 4D TRAK-3D TFE sequences. TTE and maximum slope (MS) were derived from the ultrafast MRI. The repeated measures ANOVA, Mann-Whitney U test and Kruskal-Wallis H test were performed to compare the median TTE, MS and SER according to histologic type, histologic grade, ER/PR/HER2 positivity, level of Ki-67 and tumour subtype. For TTE calculation, intraclass correlation coefficient (ICC) was used to evaluate interobserver variability.Results: The median TTE of invasive cancers was shorter than that of in situ cancers (p < 0.001). In invasive cancers, large tumours showed shorter TTE than small tumours (p = 0.001). High histologic/nuclear grade cancers had shorter TTE than low to intermediate grade cancers (p < 0.001 and p < 0.001). HER2-positive cancers showed shorter TTE than HER2-negative cancers (p = 0.001). The median TTE of cancers with high Ki-67 was shorter than that of cancers with low Ki-67 (p < 0.001). ICC between two readers showed moderate agreement (0.516). No difference was found in the median MS or SER values according to the clinicopathologic features.Conclusions: The median TTE of breast cancer in ultrafast MRI was shorter in invasive or aggressive tumours than in in situ cancer or less aggressive tumours, respectively.Key Points: • Invasive breast tumours show a shorter TTE in ultrafast DCE-MRI than in situ cancers. • A shorter TTE in ultrafast DCE-MRI is associated with breast tumours of a large size, high histologic or nuclear grade, PR negativity, HER2 positivity and high Ki-67 level. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively investigate whether the lesion-to-background parenchymal signal enhancement ratio (SER) on breast MRI can distinguish pathological complete response (pCR) from minimal residual cancer following neoadjuvant chemotherapy (NAT), and compare its performance with the conventional criterion.Methods: 216 breast cancer patients who had undergone NAT and MRI and achieved pCR or minimal residual cancer on surgical histopathology were included. Clinical-pathological features, SER and lesion size on MR images were analysed. Multivariate logistic regression, ROC curve and McNemar's test were performed.Results: SER on early-phase MR images was independently associated with pCR (odds ratio [OR], 0.286 [95% CI: 0.113-0.725], p = .008 for Reader 1; OR, 0.306 [95% CI: 0.111-0.841], p = .022 for Reader 2). Compared with the conventional criterion, SER ≤1.6 increased AUC (0.585-0.599 vs. 0.709-0.771, p=.001-.033) and specificity (21.9-27.4% vs. 80.8-86.3%, p <.001) in identifying pCR. SER ≤1.6 and/or size ≤0.2 cm criterion showed the highest specificity of 90.4%.Conclusion: SER on early-phase MR images was independently associated with pCR, and showed improved AUC and specificity compared to the conventional criterion. The combined criterion of SER and size could be used to select candidates to avoid surgery in a future study.Key Points: • Compared with conventional criterion, SER ≤ 1.6 criterion increased AUC and specificity. • Simple measurement of signal intensity could differentiate pCR from minimal residual cancer. • SER ≤1.6 and/or size≤0.2cm criterion showed the highest specificity of 90.4 %. • The combined criterion could be used for a study to avoid surgery. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether mass stiffness measured by shear-wave elastography (SWE) can predict the histological upgrade of ductal carcinoma in situ (DCIS) confirmed through ultrasound (US)-guided core needle biopsy (CNB).Methods: The institutional review board approved this study and informed consent was waived. A database search revealed 120 biopsy-confirmed DCIS in patients who underwent B-mode US and SWE prior to surgery. Clinicopathologic results, B-mode findings, size on US, and mean and maximum elasticity values on SWE were recorded. Associations between upgrade to invasive cancer and B-mode US findings, SWE information, and clinical variables were assessed using univariate, multivariate logistic regression, and multiple linear regression analysis.Results: The overall upgrade rate was 41.7 % (50/120). Mean stiffness value (P = .014) and mass size (P = .001) were significantly correlated with histological upgrade. The optimal cut-off value of mean stiffness value, yielding the maximal sum of sensitivity and specificity, was 70.7 kPa showing sensitivity of 72 % and specificity of 65.7 % for detecting invasiveness. Qualitative elasticity colour scores were significantly correlated with the histological upgrade, mammographic density, and B-mode category (P < .04).Conclusion: Mean stiffness values evaluated through SWE can be utilized as a preoperative predictor of histological upgrade to invasive cancer in DCIS confirmed at US-guided needle biopsy.Key Points: • Higher stiffness values were noted in invasive cancer than DCIS. • Qualitative SWE colour scores significantly correlated with the histological upgrade. • Qualitative SWE colour scores had excellent interobserver agreement. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic performance of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to mammography in women with known breast cancers.Methods: Three radiologists independently reviewed image sets of 172 patients with 184 cancers; mammography alone, DBT plus mammography and MRI plus mammography, and scored for cancer probability using the Breast Imaging Reporting and Data System (BI-RADS). Jack-knife alternative free-response receiver-operating characteristic (JAFROC), which allows diagnostic performance estimation using single lesion as a statistical unit in a cancer-only population, was used. Sensitivity and positive predictive value (PPV) were compared using the McNemar and Fisher-exact tests.Results: The JAFROC figures of merit (FOMs) was lower in DBT plus mammography (0.937) than MRI plus mammography (0.978, P = 0.0006) but higher than mammography alone (0.900, P = 0 .0013). The sensitivity was lower in DBT plus mammography (88.2 %) than MRI plus mammography (97.8 %) but higher than mammography alone (78.3 %, both P < 0 .0001). The PPV was significantly higher in DBT plus mammography (93.3 %) than MRI plus mammography (89.6 %, P = 0 .0282).Conclusions: DBT provided lower diagnostic performance than MRI as an adjunctive imaging to mammography. However, DBT had higher diagnostic performance than mammography and higher PPV than MRI.Key Points: • Digital breast tomosynthesis (DBT) plus mammography was compared with MRI plus mammography. • DBT had lower sensitivity and higher PPV than MRI. • DBT had higher diagnostic performance than mammography. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a correlation exists between maximum standardized uptake value (SUVmax) on (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and the subtypes of breast cancer.Methods: This retrospective study involved 548 patients (mean age 51.6 years, range 21-81 years) with 552 index breast cancers (mean size 2.57 cm, range 1.0-14.5 cm). The correlation between (18)F-FDG uptake in PET/CT, expressed as SUVmax, and immunohistochemically defined subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) positive and triple negative) was analyzed.Results: The mean SUVmax value of the 552 tumours was 6.07 ± 4.63 (range 0.9-32.8). The subtypes of the 552 tumours were 334 (60%) luminal A, 66 (12%) luminal B, 60 (11%) HER2 positive and 92 (17%) triple negative, for which the mean SUVmax values were 4.69 ± 3.45, 6.51 ± 4.18, 7.44 ± 4.73 and 9.83 ± 6.03, respectively. In a multivariate regression analysis, triple-negative and HER2-positive tumours had 1.67-fold (P < 0.001) and 1.27-fold (P = 0.009) higher SUVmax values, respectively, than luminal A tumours after adjustment for invasive tumour size, lymph node involvement status and histologic grade.Conclusion: FDG uptake was independently associated with subtypes of invasive breast cancer. Triple-negative and HER2-positive breast cancers showed higher SUVmax values than luminal A tumours.Key Points: • (18) F-FDG PET demonstrates increased tissue glucose metabolism, a hallmark of cancers. • Immunohistochemically defined subtypes appear significantly associated with FDG uptake (expressed as SUV max ). • Triple-negative tumours had 1.67-fold higher SUV max values than luminal A tumours. • HER2-positive tumours had 1.27-fold higher SUV max values than luminal A tumours. [ABSTRACT FROM AUTHOR]

Background: Our aim was to compare the accuracy of magnetic resonance imaging (MRI) and ultrasonography (US) in measuring the size of invasive breast cancer (IBC) and carcinoma in situ (CIS). We also examined the utility of routinely performing MRI in addition to US before breast-conserving surgery (BCS). Patients and Methods: Data from 1558 consecutive patients diagnosed with IBC and/or CIS between 2003 and 2005 were reviewed. For comparing the accuracy of US and MRI, paired t test was done comparing pathologic and imaging (US and MRI) tumor size in 821 patients who received both breast US and MRI. In instance of attempted BCS ( n = 794), operative approach, resection margins, and clinical outcomes of non-MRI and MRI groups were compared. Results: For CIS, IBC without CIS, and IBC with CIS, MRI was more accurate in estimating tumor size than US. When BCS was attempted ( n = 794), the rate of tumor involvement in initial resection margins did not differ between non-MRI and MRI groups (23.0% and 23.4%, P = .926). Similarly, rates of re-excision (13.1% vs 17.5%, P = .130) and conversion to mastectomy (2.3% vs 2.1%, P = .893) were comparable, as were ipsilateral breast tumor recurrence, locoregional recurrence, and disease-free survival (log rank P = .284, .950, and .955, respectively). Conclusions: Breast MRI provided more accurate estimates of tumor size, correlating better with pathologic tumor size than US for both IBC and CIS. However, no clear benefit in terms of lower re-excision rate, higher breast conservation success, or reduced recurrence emerged for routine use of breast MRI before BCS. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic value of sonoelastography by correlation with histopathology compared with conventional ultrasound on the decision to biopsy.Methods: Prospectively determined BI-RADS categories of conventional ultrasound and elasticity scores from strain sonoelastography of 1786 non-palpable breast masses (1,523 benign and 263 malignant) in 1,538 women were correlated with histopathology. The sensitivity and specificity of two imaging techniques were compared regarding the decision to biopsy. We also investigated whether there was a subset of benign masses that were recommended for biopsy by B-mode ultrasound but that had a less than 2% malignancy rate with the addition of sonoelastography.Results: The mean elasticity score of malignant lesions was higher than that of benign lesions (2.94 ± 1.10 vs. 1.78 ± 0.81) (P < 0.001). In the decision to biopsy, B-mode ultrasound had higher sensitivity than sonoelastography (98.5% vs. 93.2%) (P < 0.001), whereas sonoelastography had higher specificity than B-mode ultrasound (42.6% vs. 16.3%) (P < 0.001). BI-RADS category 4a lesions with an elasticity score of 1 had a malignancy rate of 0.8%.Conclusions: Sonoelastography has higher specificity than B-mode ultrasound in the differentiation between benign and malignant masses and has the potential to reduce biopsies with benign results.Key Points: • Sonoelastography has higher specificity than B-mode ultrasound in distinguishing benign from malignant masses. • Sonoelastography could potentially help reduce the number of biopsies with benign results. • Lesion stiffness on sonoelastography correlated with the malignant potential of the lesion. [ABSTRACT FROM AUTHOR]

Objective: To compare the use of diffusion-weighted MR imaging (DWI) and (18)F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy.Methods: Thirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis.Results: After surgery, 7/34 patients (20.6%) were found to have pCR. A( z ) values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI.Conclusions: DWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate whether sonoelastographic evaluation could help predict the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy.Methods: One hundred and three consecutive nonpalpable DCIS lesions diagnosed at US-guided needle biopsy were analyzed. To identify the preoperative factors associated with upgrade to invasive cancers on surgical histology, lesion size, B-mode US findings, elasticity score, biopsy variables, and histological variables were analyzed using univariate and multivariate logistic regression. Interobserver agreement for the elasticity score was evaluated using the multi-rater κ statistics.Results: The overall upgrade rate was 23% (24 of 103). Elasticity score was found to be the only independent predictor of invasion. The upgrade rates according to the median elasticity score was 6.7% (1 of 15) for a score of 1, 20.6% (13 of 63) for a score of 2, and 40.0% (10 of 25) for a score of 3 (Odds ratio [OR] = 1; OR = 4.19, P = 0.207; OR = 12.32, P = 0.039, respectively). No association was found between other factors and the upgrade rate. The overall interobserver agreement for the elasticity score was moderate (κ = 0.587; P < .001).Conclusions: Sonoelastographic lesion stiffness is an independent preoperative predictor of invasion in some patients with nonpalpable DCIS at US-guided needle biopsy. [ABSTRACT FROM AUTHOR]

Objective: To prospectively determine the upgrade rate following surgery in benign papilloma initially diagnosed at ultrasound (US)-guided 14-gauge gun biopsy.Methods: A total of 128 benign papillomas were diagnosed in 114 patients after a US-guided biopsy. Surgical excision was recommended where the biopsy indicated benign papilloma, regardless of imaging findings. The upgrade rate to 'atypical' and 'malignancy' was measured on a per-lesion basis. We analysed potential associations between clinical presentation, lesion variables and the results of surgical excision (using logistic regression).Results: Of the 114 patients, 87 eventually underwent surgery: among the 100 supposed benign papillomas, surgical excision revealed fibrocystic change or no residual lesion in nine cases, intraductal papilloma in 74, atypical papilloma in 13, papillary ductal carcinoma in situ (DCIS) in three and one invasive papillary carcinoma. The upgrade rate for an atypical papilloma or papilloma with adjacent foci of atypical ductal hyperplasia (ADH) and malignancy was 13% (95% CI = 7.1-21.2%) and 4% (95% CI = 1.1-9.9%), respectively. The mean lesion size (P = 0.041) was significantly larger when lesions were upgraded to malignancy. Other features were not significantly associated with pathological underestimation (P > 0.05).Conclusion: Surgical excision should be considered for benign intraductal papillomas above 1.5 cm in size. [ABSTRACT FROM AUTHOR]

This study was to evaluate the performance of commercially available artificial intelligence (AI) software in unilateral mammograms simulating postmastectomy surveillance compared with AI software used in bilateral mammograms from the same women serving as controls. A retrospective database search identified consecutive women who underwent breast cancer surgery between January 2021 and December 2021. AI software was applied to the mammogram immediately preceding breast cancer diagnosis in two modes: bilateral (the standard bilateral mammography dataset) and unilateral analyses (each breast's craniocaudal and mediolateral oblique views), and their outputs were reviewed. The sensitivity, specificity, and number of marks per breast were compared between the bilateral and unilateral analyses with -5% non-inferiority margin for the difference in sensitivity and specificity between the two modes. A total of 694 women (mean age, 55.2 ± 10.8 years) with unilateral or bilateral breast cancer contributed mammograms for analysis; each breast was then separately evaluated in the unilateral postmastectomy simulation (n = 1388), of which 730 had breast cancer (52.6%) (mean invasive size = 1.5 cm) and compared with bilateral mammography analysis. The sensitivity of unilateral analysis was not inferior to that of bilateral analysis (78.6% vs. 76.7%), with a difference of 1.9%. The specificity of unilateral analysis was inferior to that in the bilateral analysis (81.5% vs. 91.9%), with a difference of -10.5% being lower than the non-inferiority margin. The average number of AI marks per breast was 0.94 (unilateral [1298/1388] and bilateral analyses [1306/1388], respectively). AI software performance in simulated unilateral mammography analysis demonstrated non-inferior sensitivity and inferior specificity compared to bilateral mammography., Competing Interests: Declarations. Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Seoul National University Hospital (IRB No. 2304–083-1423). Informed Consent Statement: Patient consent was waived due to retrospective nature of the study. Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© 2025. The Author(s) under exclusive licence to Society for Imaging Informatics in Medicine.)