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OBJECTIVE: To predict the occult tumor involvement of nipple-areola complex (NAC) using preoperative MR imaging and to investigate whether the intraoperative histopathological examination of the subareolar tissue is still necessary. PATIENTS AND METHODS: Out of 712 patients submitted to nipple-sparing mastectomy (NSM) between 2014 and 2019, we selected 188 patients who underwent preoperative breast MRI. Breast MRI and intraoperative histopathological examination of the subareolar tissue were performed to predict NAC involvement at permanent pathology. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. RESULTS: Forty-three patients (22.9%) had tumor involvement of the NAC. At univariate analysis, non-mass enhancement type (p = 0.009), multifocality/multicentricity (p = 0.002), median tumor size (p < 0.001), median tumor-NAC distance measured by MRI (p < 0.001), tumor-NAC distance ≤ 10 mm (p < 0.001) and tumor-NAC distance ≤ 20 mm (p < 0.001), and lymphovascular invasion (p = 0.001) were significantly correlated with NAC involvement. At multivariate analysis, only tumor-NAC distance ≤ 10 mm retained statistical significance. The sensitivity and specificity of MRI tumor-NAC distance ≤ 10 mm were 79.1% and 97.2% and those of intraoperative pathologic assessment were 74,4% and 100%, respectively. CONCLUSIONS: Tumor-NAC distance is the only reliable MRI characteristic that can predict NAC involvement in breast cancer patients. Although several cut-offs showed promising performances, intraoperative pathologic assessment is still mandatory. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the diagnostic performance of unenhanced MRI (UEMRI) for malignant breast lesions and its reproducibility. PATIENTS AND METHODS: We retrospectively included 118 patients who had breast MRI. DWI and STIR images were read in combination and referred to as UE-MRI; the presence or absence of the malignant lesion was noted by two observers. Their results were compared with those of final histopathology or with a two-year negative follow-up for diagnostic performance assessment; ROC curves were built. Diagnostic performance was stratified according to lesion site and size. Interobserver agreement was evaluated through the Cohen's k statistic. RESULTS: Specificity of STIR and DWI was 99.3% and 95.7% for Reader 1; 99.3% and 96.4% for Reader 2. Sensitivity was 76.5% and 76.5% for Reader 1; 77.5% and 77.6% for Reader 2. The ROC AUC (Reader 1) was 0.869 and 0.844 for STIR and DWI, respectively (p<0.001 both); for Reader 2, values were 0.874 and 0.853 respectively (p<0.001 both). Lesion dimension =10 mm was associated with lower AUC values. Lesion site didn't influence the diagnostic performance. Interobserver agreement was very good for STIR and DWI (k=0.887, p <0.001, and k=0.867, p <0.001). DISCUSSION: UE-MRI has a good overall diagnostic performance in the detection of breast cancer and a very good specificity for both STIR and DWI sequences. We observed reduced diagnostic performance for lesions =10 mm in size. Lesion's site isn't associated with a significantly decreased diagnostic performance of UE-MRI. There's a good interobserver agreement for both sequences (STIR and DWI). CONCLUSIONS: UE-MRI may be employed in patients with contraindication to gadolinium. It has considerable specificity and positive predictive value and good reproducibility. [ABSTRACT FROM AUTHOR]

This work aims at assessing different Uncertainty Quantification (UQ) methodologies for the stochastic analysis and robust design of Organic Rankine Cycle (ORC) turbines under multiple uncertainties. Precisely, we investigate the capability of several state-of-the art UQ methods to efficiently and accurately compute the average and standard deviation of the aerodynamic performance of supersonic ORC turbine expanders, whose geometry is preliminarily designed by means of a generalized Method Of Characteristics (MOC). Stochastic solutions provided by the adaptive Simplex Stochastic Collocation method, a Kriging-based response surface method, and a second-order accurate Method of Moments are compared to a reference solution obtained by running a full-factorial Probabilistic Collocation Method (PCM). The computational cost required to estimate the average adiabatic efficiency, Mach number and pressure coefficient, as well as their standard deviations, to within a given tolerance level is compared, and conclusions are drawn about the more suitable method for the robust design of ORC turbines. [ABSTRACT FROM AUTHOR]

Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.

(1) Background: To help to refine the accuracy of sentinel lymph node biopsy (SLNB) in breast cancer (BC) patients with biopsy-proven nodal disease prior to neoadjuvant chemotherapy (NACT), a method of marking the biopsy-proven positive LN at diagnosis to enable its removal during surgery was proposed. The aim of this study was to evaluate the accuracy of the Radio-Guided Occult Lesion Localization (ROLL) technique of biopsy-proven metastatic LN in nodal staging after NACT among node-positive BC patients. (2) Methods: Patients with invasive BC and biopsy-proven axillary metastases receiving NACT were enrolled. A clip marker was placed on the sampled LN (clipped lymph node, CLN) before NACT. Before surgery, the ROLL procedure (radioactive tracer injection into CLN under ultrasound guidance) was performed, and the CLN was surgically resected. The correspondence between the CLNs and SLNs was evaluated. The pathologic findings of the CLNs and SLN(s) were compared with remaining axillary nodes at ALND to determine false negative rates (FNRs). (3) Results: Seventy-two patients were analyzed. Surgery successfully identified the CLN in 70/72 procedures (97.2%). For 60/72 patients who underwent ALND, the FNRs dropped from 19.35% for SLNB to 3.13% for CLN biopsy. (4) Conclusions: The ROLL procedure got CLNs is accurate in axillary nodal staging after NACT in node-positive BC patients at diagnosis.

Neoadjuvant chemotherapy (NACT) today represents a cornerstone in the treatment of locally advanced breast cancer and highly chemo-sensitive tumors at early stages, increasing the possibilities of performing more conservative treatments and improving long term outcomes. Imaging has a fundamental role in the staging and prediction of the response to NACT, thus aiding surgical planning and avoiding overtreatment. In this review, we first examine and compare the role of conventional and advanced imaging techniques in preoperative T Staging after NACT and in the evaluation of lymph node involvement. In the second part, we analyze the different surgical approaches, discussing the role of axillary surgery, as well as the possibility of non-operative management after-NACT, which has been the subject of recent trials. Finally, we focus on emerging techniques that will change the diagnostic assessment of breast cancer in the near future.

Breast cancer (BC) is the most common cancer among women worldwide. Neoadjuvant chemotherapy (NACT) indications have expanded from inoperable locally advanced to early-stage breast cancer. Achieving a pathological complete response (pCR) has been proven to be an excellent prognostic marker leading to better disease-free survival (DFS) and overall survival (OS). Although diagnostic accuracy of MRI has been shown repeatedly to be superior to conventional methods in assessing the extent of breast disease there are still controversies regarding the indication of MRI in this setting. We intended to review the complex literature concerning the tumor size in staging, response and surgical planning in patients with early breast cancer receiving NACT, in order to clarify the role of MRI. Morphological and functional MRI techniques are making headway in the assessment of the tumor size in the staging, residual tumor assessment and prediction of response. Radiomics and radiogenomics MRI applications in the setting of the prediction of response to NACT in breast cancer are continuously increasing. Tailored therapy strategies allow considerations of treatment de-escalation in excellent responders and avoiding or at least postponing breast surgery in selected patients.

Purpose: The purpose of this study was to retrospectively investigate whether background parenchymal enhancement (BPE) of the contralateral breast on magnetic resonance imaging (MRI) is associated with clinical outcomes in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy (NAC)., Materials and Methods: A total of 228 women (47.6 years ± 10 [SD]; range: 24-74 years) with invasive breast cancer who underwent NAC between 2005 and 2013 were included. All included patients underwent breast MRI before and after NAC. Quantitative semiautomated analysis of BPE of the contralateral healthy breast was performed. The enhancement level on baseline MRI (baseline BPE) and on MRI after chemotherapy (final BPE) and the change in enhancement rate between baseline MRI and final MRI were recorded. Cox regression was used to test associations between BPE variables, patient and tumor characteristics, overall survival (OS) and disease-free survival (DFS). Subgroup analyses based on menopausal status and immunohistochemical subtypes were performed., Results: Median follow-up was 92 months. Multivariable analysis revealed that Ki-67 level (P = 0.026) and receipt of mastectomy (P = 0.015) were independent variables associated with OS while Ki-67 level (P = 0.010) and post-NAC pathological node categorization (P = 0.027) were independent variables associated with DFS. BPE was not associated with OS (P = 0.500, 0.546 and 0.712 for baseline BPE, final BPE and BPE change, respectively) or with DFS (P = 0.568, 0.412 and 0.327, respectively)., Conclusion: BPE of the contralateral breast on MRI may have limited prognostic value in patients with breast cancer treated with NAC., Competing Interests: Declarations of Competing Interest The authors declare that they have no conflict of interest to disclose in relation with this article., (Copyright © 2022. Published by Elsevier Masson SAS.)

The correct N-staging in breast cancer is crucial to tailor treatment and stratify the prognosis. N-staging is based on the number and the localization of suspicious regional nodes on physical examination and/or imaging. Since clinical examination of the axillary cavity is associated with a high false negative rate, imaging modalities play a central role. In the presence of a T1 or T2 tumor and 0-2 suspicious nodes, on imaging at the axillary level I or II, a patient should undergo sentinel lymph node biopsy (SLNB), whereas in the presence of three or more suspicious nodes at the axillary level I or II confirmed by biopsy, they should undergo axillary lymph node dissection (ALND) or neoadjuvant chemotherapy according to a multidisciplinary approach, as well as in the case of internal mammary, supraclavicular, or level III axillary involved lymph nodes. In this scenario, radiological assessment of lymph nodes at the time of diagnosis must be accurate. False positives may preclude a sentinel lymph node in an otherwise eligible woman; in contrast, false negatives may lead to an unnecessary SLNB and the need for a second surgical procedure. In this review, we aim to describe the anatomy of the axilla and breast regional lymph node, and their diagnostic features to discriminate between normal and pathological nodes at Ultrasound (US) and Magnetic Resonance Imaging (MRI). Moreover, the technical aspects, the advantage and limitations of MRI versus US, and the possible future perspectives are also analyzed, through the analysis of the recent literature.

Objectives: To conduct a review of evidence about papillomatosis/multiple papillomas (MP), its clinical and imaging presentation, the association between MP and malignancy and the management strategies that follow., Methods: A computerized literature search using PubMed and Google Scholar was performed up to January 2021 with the following search strategy: "papilloma" OR "intraductal papilloma" OR "intraductal papillary neoplasms" OR "papillomatosis" OR "papillary lesion" AND "breast". Two authors independently conducted a search, screening and extraction of data from the eligible studies., Results: Of the 1881 articles identified, 29 articles met the inclusion criteria. The most common breast imaging methods (mammography, ultrasound) showed few specific signs of MP, and evidence about magnetic resonance imaging were weak. Regarding the association between MP and malignancy, the risk of underestimation to biopsy methods and the frequent coexistence of MP and other high-risk lesions needs to be taken into consideration. Results about the risk of developing breast carcinoma of patients affected by MP were inconsistent., Conclusions: MP is a challenge for all breast specialists, and familiarity with its features is required to make the correct diagnosis. Further studies are needed to evaluate the factors to take into account to plan management, time of follow-up and imaging methods.

Background: Among the various complications associated with total hip arthroplasty (THA) periprosthetic osteolysis and wear phenomena due to the release of metal particles, are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects. Therein, new masses known as pseudotumors can appear in soft tissues around a prosthetic implant. To date, there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events., Aim: To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants., Methods: Overall, 76 patients were divided into three groups according to the type of hip prosthesis implants: Monoblock, modular with metal head and modular with ceramic head. With an average f-up of 4 years, we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum. Moreover, serum and urinary tests were performed to assess the values of Chromium and Cobalt released. Statistical analysis was performed to determine any association between the ion release and osteolysis., Results: For the 3 study groups, the monolithic, modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events, which were higher for the modular implants. Furthermore, the most serious of these (grade 3) were detected almost exclusively for the modular implants with metal heads. A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level, and in the supero-external region at the acetabular level. Regarding the evaluation of the release of metals-ions from wear processes, serum and urinary chromium and cobalt values were found to be higher in cases of modularity, and even more so for those with metal head. Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis. However, no cases of pseudo-tumor were detected., Conclusion: Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events, including osteolysis and aseptic loosening., Competing Interests: Conflict-of-interest statement: The Authors declare that there is no conflict of interest., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objectives: To investigate the role of automated breast volume scanner (ABVS) compared to handheld ultrasound (HHUS) and contrast-enhanced magnetic resonance imaging (CE-MRI) in the early detection of patients with locally advanced breast cancer who are more likely to reach a complete pathological response (pCR) during neoadjuvant chemotherapy (NAC)., Methods: A single-institution prospective study was performed in patients with histological diagnosis of invasive breast cancer, eligible for NAC, and who were to undergo surgery in our Hospital. Imaging examinations with ABVS, HHUS and CE-MRI were performed at diagnosis (basal time) and after 3 months of chemotherapy (middle time). The tumor size of each lesion was measured at the basal and middle times, and the dimensional variation was reported. Based on this, patients were divided dichotomously by the median value, obtaining "good responders" (goodR) versus "poor responders" (poorR). The results were correlated with the histological assessment (pCR versus No-pCR) with the use of the intergroup comparison of categorical data (Fisher's exact test)., Result: A total of 21 patients were included; 5 obtained a pCR (23%). Both the ABVS and the CE-MRI found all 5 patients with pCR in the group of goodR (10 patients), while none of the poorR (11 patients) obtained a pCR [correlation was statistically significant (p 0.01)]. In the HHUS, goodR (10 patients) 1 obtained a pCR while in the poorR (11 patients) 4 obtained a pCR [correlation not statistically significant (p 0.31)]., Conclusions: ABVS could be a useful tool, appearing to be more reliable than HHUS, and as accurate as CE-MRI, in early detection of patients who could reach a pCR after NAC.

Objectives: To conduct a systematic review of evidences about the relationship between background parenchymal enhancement (BPE) of the contralateral healthy breast and breast cancer: its association with clinicopathological breast cancer characteristics, its potential as predictive and prognostic biomarker and the biological linkage between BPE and breast cancer., Methods: A computerized literature search using PubMed and Google Scholar was performed up to June 2020. Two authors independently conducted search, screening, quality assessment, and extraction of data from the eligible studies. Studies were assessed for quality and risk of bias using the revised Quality Assessment of Diagnostic Accuracy Studies tool., Results: Of the 476 articles identified, 22 articles met the inclusion criteria. No significant association was found between BPE and invasiveness, histological cancer type, T- and N-stage, multifocality, lymphatic and vascular invasion and histological tumour grade while the association between BPE and molecular subtypes is still unclear. As predictive biomarker, a greater decrease in BPE during and after neoadjuvant chemotherapy was associated with pathological complete response. Results about the role of BPE as prognostic factor were inconsistent. An association between high BPE and microvessel density, CD34 and VEGF (histological markers of vascularization and angiogenesis) was found., Conclusions: BPE of the contralateral breast is associated with breast cancer in several aspects, therefore it has been proposed as a tool to refine breast cancer decision-making process., Advances in Knowledge: Additional researches with standardized BPE assessment are needed to translate this emerging biomarker into clinical practice in the era of personalized medicine.

Purpose: To analyse the influence of tumor volume/breast volume ratio (TV/BV ratio) measured on magnetic resonance imaging (MRI) and other factors on surgeons' choice between large volume displacement oncoplastic surgery (LVOS) versus mastectomy (M) in patients with large sized tumors. Secondly, we investigate the predictive value of TV/BV ratio and other possible predictors for cosmetic results., Materials and Methods: We retrospectively reviewed 80 MRI examinations performed on 77 breast cancer patients who underwent M (58 breasts, 72.5%) or LVOS (22 breasts, 27.5%) at our institution between January 2016 and December 2017. The TV and BV measurements were performed by a semiautomated analysis and the TV/BV ratio was calculated by dividing TV by BV in cm3 and multiplying it by 1,000. Cosmetic result was determined by an expert panel assessment of postoperative photographs., Results: Median TV/BV was significantly higher in the M group (44,8 IQR 17,3-93,6) than in the LVOS group (17,5 IQR 11,7-57,5) (P=0.002). Multifocal/multicentric disease (P=0.005), lower degree of breast ptosis (P<0.0001) and unfavourable tumor location (P=0.024) are significantly more frequent in the M group. After multivariable linear regression, the independent predictors for cosmetic result were: unfavourable tumor location (OR 6.637 95% CI 1.564- 28.172 P=0.010) and a higher TV/BV ratio (OR 4.907 95% CI 1.461-16.478 P=0.010) CONCLUSION: Preoperative evaluation of TV/BV ratio, tumor location and tumor multifocality/multicentricity could improve treatment decision making (LVOS versus M) in breast cancer patient eligible for both options. Increasing TV/BV ratio and unfavourable tumor location are adversely affecting cosmetic result., Key Words: Breast cancer, Magnetic Resonance Imaging, Mastectomy, Large volume displacement oncoplastic surgery, Tumor volume/breast volume.

Purpose: The aim of the study was to verify whether ultrasound (US)-guided preoperative localization of breast lesions is an adequate technique for correct and safe surgical resection and to contribute positively and effectively to this topic in the literature with our results., Methods: From June 2016 to November 2016, 155 patients with both benign and malignant breast lesions were selected from our institute to undergo US localization before surgery. The lesions included were: sonographically visible and nonpalpable lesions; palpable lesions for which a surgeon had requested US localization to better evaluate the site and extension; sonographically visible, multifocal breast lesions, both palpable and nonpalpable. US localization was performed using standard linear transducers (Siemens 18 L6, 5.5-8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solutions). The radiologist used a skin pen to mark the site of the lesion, and the reported lesion's depth and distance from the nipple and pectoral muscle were recorded. The lesions were completely excised by a team of breast surgeons, and the surgical specimens were sent to the Radiology Department for radiological evaluation and to the Pathology Department for histological assessment., Results: In 155 patients who underwent to preoperative US localization, 188 lesions were found, and the location of each lesion was marked with a skin pen. A total of 181 lesions were confirmed by the final histopathologic exam (96.28%); 132 of them (72.92%) were malignant, and 124 of these (93.93%) showed free margins., Conclusions: US-guided preoperative localization of sonographically visible breast lesions is a simple and nontraumatic procedure with high specificity and is a useful tool for obtaining accurate surgical margins.

To develop a predictive scoring system for ultrasound-detected B3 lesions at ultrasound-guided core needle biopsy (US-CNB). A total of 2724 consecutive US-CNBs performed in our Institution (January 2011 to December 2014) were retrospectively reviewed. Inclusion criteria were as follows: (a) histopathological examination of the entire lesion or (b) availability of radiologic follow-up (FUP) ≥24 months. Patient- and lesion-related variables-patients' age, lesion consistency, lesion size, vascularization, BI-RADS category, and US-CNB result-were analyzed. Positive predictive values (PPVs) for malignancy were calculated correlating US-CNB results with excision histology or FUP. A scoring system for underlying malignancy was developed using risk factors weighting. A total of 102 B3 lesions were included: 27 atypical ductal hyperplasia (26.5%), 5 lobular intraepithelial neoplasia (4.9%), 32 radial scar (31.4%), 37 papillary lesions (36.3%), and 1 fibroepithelial lesion (0.9%). Surgery was performed on 71/102 (69.6%) lesions, and 22/71 were malignant; the remaining 31/102 lesions (30.4%) were unchanged at FUP. The overall PPV for malignancy was 21.6%. Patients' age (odds ratio [OR] = 3.63, P = 0.008), lesion consistency (OR = 5.96, P = 0.001), BI-RADS category (OR = 17.52, P < 0.001), and CNB result (OR = 3.6, P = 0.008) were associated with a higher risk of malignancy underestimation and selected as risk factors in the score definition. Two risk groups were identified: low (0-2 points) and high risk (3-5 points), with significantly different risk of malignancy underestimation (8.0% vs 59.3%, P < 0.001). The proposed score helps to predict the risk of malignancy underestimation and choose the management of B3 lesions at US-CNB., (© 2018 Wiley Periodicals, Inc.)

Automated breast ultrasonography (ABUS) is a new imaging technology for automatic breast scanning through ultrasound. It was first developed to overcome the limitation of operator dependency and lack of standardization and reproducibility of handheld ultrasound. ABUS provides a three-dimensional representation of breast tissue and allows images reformatting in three planes, and the generated coronal plane has been suggested to improve diagnostic accuracy. This technique has been first used in the screening setting to improve breast cancer detection, especially in mammographically dense breasts. In recent years, numerous studies also evaluated its use in the diagnostic setting: they showed its suitability for breast cancer staging, evaluation of tumor response to neoadjuvant chemotherapy, and second-look ultrasound after magnetic resonance imaging. The purpose of this article is to provide a comprehensive review of the current body of literature about the clinical performance of ABUS, summarize available evidence, and identify gaps in knowledge for future research., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of the present study was to assess the diagnostic accuracy of ultrasound-guided core needle biopsy (US-CNB) of breast lesions, comparing smaller needles (16- and 18-gauge) with the 14-gauge needle, and to analyze the lesion characteristics influencing US-CNB diagnostic performance., Patients and Methods: All the patients provided informed consent before the biopsy procedure. The data from breast lesions that had undergone US-CNB in our institution from January 2011 to January 2015 were retrospectively reviewed. The inclusion criterion was the surgical histopathologic examination findings of the entire lesion or radiologic follow-up data for ≥ 24 months. The exclusion criterion was the use of preoperative neoadjuvant therapy. The US-CNB results were compared with the surgical pathologic results or with the follow-up findings in the 3 needle size groups (14-, 16-, and 18-gauge). The needle size- and lesion characteristic-specific diagnostic accuracy parameters were evaluated. Statistical analysis was performed using a dedicated software program, and P ≤ .01 was considered significant., Results: A total of 1118 US-CNB cases (1042 patients) were included. Of the 1118 cases, 630 (56.3%) were in the 14-gauge group, 136 (12.2%) in the 16-gauge, and 352 (31.5%) in the 18-gauge needle group. Surgery was performed on 800 lesions (71.6%). Of these, 619 were malignant, 77 were high risk, and 104 were benign. The remaining 318 lesions (28.4%) underwent follow-up imaging studies. All the lesions were stable and, therefore, were considered benign. No differences were observed in the diagnostic accuracy parameters among the 3 needle size groups (P > .01). The false-negative rate was greater for lesions < 10 mm (7.2%) (P < .01) but without statistically significant differences among the 3 gauges (P > .01)., Conclusion: US-CNB performed with small needles (16 and 18 gauge) had the same diagnostic accuracy as that performed with 14-gauge needles, regardless of the lesion characteristics., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Our objective was to investigate the relationship between asymmetric increase in breast vascularity (AIBV) and pathologic profiles of breast cancer. We also addressed the prognostic performance of AIBV and of vascular maps reduction after neoadjuvant chemotherapy (NAC) in predicting pathologic complete response (pCR) at surgery and outcome at follow-up., Materials and Methods: Two hundred nineteen patients with unilateral locally advanced breast cancer (LABC) underwent magnetic resonance imaging before and after NAC. Axial, sagittal, and coronal maximum intensity projections were obtained in a subjective comparative evaluation. Asymmetrical versus symmetrical breast vascularity was defined through number of vessels, diameter, and signal intensity. Kaplan-Meier methodology was employed for late survival (31.4 ± 18 months follow-up)., Results: AIBV ipsilateral to LABC occurred in 62.5% (P < .001). AIBV was significantly associated with invasive ductal carcinoma, G3, triple-negative, HER2+, and hybrid phenotypes (P < .001). pCR was more frequent among patients with AIBV (24%) (P = .001). After NAC, the vascular map was significantly reduced, particularly in patients with pCR (P < .001). At follow-up, the recurrence rate was 22% (6.1% mortality). AIBV after NAC was associated with worse late survival (P = .036). A trend towards worse late survival existed among patients with AIBV before NAC. We did not observe statistically different survival according to the variation of vascularity after NAC., Conclusion: LABC with ipsilateral AIBV before NAC is associated with more aggressive pathologic profiles. Nonetheless, it is more sensitive to NAC and shows a higher frequency of pCR. The persistence of AIBV after NAC entails a worse late prognosis and should prompt more aggressive therapeutic strategies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: This study aims to investigate sensitivity of breast magnetic resonance imaging (MRI) for mammographic microcalcifications-only ductal carcinoma in situ (DCIS), based on its histopathology and mammographic extent of microcalcifications., Methods: Mammograms were reviewed to measure the extent of microcalcifications. Sensitivity of MRI was calculated in the overall study population and in groups differing for DCIS nuclear grade, microinvasivity, and microcalcifications' extent., Results: Overall sensitivity of MRI was 78.3% for dynamic contrast enhanced and 66.7% for diffusion-weighted imaging and did not vary with nuclear grade and microinvasivity, while it increased with larger extent of microcalcifications (ExpB=1.063-1.046, P=.037-.013)., Conclusions: Mammographic extent of microcalcifications positively affects sensitivity of breast MRI., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To describe magnetic resonance imaging (MRI) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in surgical cavity., Materials and Methods: We retrospectively reviewed 51 MRI examinations performed between January 2009 and January 2014 in 51 patients who underwent BCS with ORC implantation., Results: In 29/51 (57 %) cases, MRIs showed abnormal findings with three main MRI patterns: (1) complex masses: hyperintense collections on T2-weighted (w) images with internal round hypointense nodules without contrast enhancement (55 %); (2) completely hyperintense collections (17 %); and (3) completely hypointense lesions (28 %). All lesions showed rim enhancement on T1w images obtained in the late phase of the dynamic study with a type 1 curve. Diffusion-weighted imaging was negative in all MRIs and, in particular, 22/29 (76 %) lesions were hyperintense but showing ADC values >1.4 × 10(-3) mm(2)/s, while the remaining 7/29 (24 %) lesions were hypointense. In four cases, linear non-mass-like enhancement was detected at the periphery of surgical cavity; these patients were addressed to a short-term follow-up, and the subsequent examinations showed the resolution of these findings., Conclusion: When applied to surgical residual cavity, ORC can lead alterations in surgical scar. This could induce radiologists to misinterpret ultrasonographic and mammographic findings, addressing patients to MRI or biopsy; so knowledge of MRI specific features of ORC, it is essential to avoid misdiagnosis of recurrence.

Purpose: The purpose of this study was to investigate potential associations between invasive breast cancer sonographic (US) findings and histopathologic patterns and biomarkers., Methods: One hundred consecutive women with invasive breast cancer treated in the Breast Diagnostic Center of Brotzu Hospital in Cagliari, Italy, from January to October 2013, were retrospectively evaluated. Two experienced breast radiologists independently evaluated hard copies of US examinations performed during the US-guided biopsy procedure. Tumor characteristics were assessed by using the BI-RADS US lexicon. For each patient, the results of histopathologic examination, tumor grading, hormone-receptor status, HER2, and Ki67 were considered. US characteristics were compared with histopathologic features and biomarkers. Statistical analysis was performed., Results: Low-grade tumors were statistically significantly associated with spiculated margins (p = 0.002) and hyperechoic halos (p < 0.001). High-grade tumors were associated with abrupt interfaces, nonspiculated margins, and absence of posterior acoustic shadowing. Malignant breast masses with spiculated margins were significantly associated with hormone-receptor positivity (p = 0.009). The most frequent tumor grade was G3 in the HER2 + and triple-negative subgroups. Patients with G3 tumors were significantly younger than those with G1 or G2 disease (51.3 ± 9.5 years versus 58.7 ± 12.6 years; p = 0.004)., Conclusions: Histopathologic patterns and breast cancer biomarkers determine differences in US imaging that can guide radiologists in better understanding the development of breast cancer and its prognosis., (© 2015 Wiley Periodicals, Inc.)

Background: We evaluated the diagnostic performance of the baseline diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the prediction of a complete pathologic response (pCR) to neoadjuvant chemotherapy (NAC) in patients with breast cancer stratified according to the tumor phenotype., Patients and Methods: We retrospectively studied 225 patients with stage II, III, and IV breast cancer who had undergone contrast-enhanced magnetic resonance imaging (MRI) and DWI before and after NAC, followed by breast surgery., Results: The tumor phenotypes were luminal (n = 143; 63.6%), triple-negative (TN) (n = 37; 16.4%), human epidermal growth factor receptor 2 (HER2)-enriched (n = 17; 7.6%), and hybrid (hormone receptor-positive/HER2(+); n = 28; 12.4%). After NAC, a pCR was observed in 39 patients (17.3%). No statistically significant difference was observed in the mean ADC value between a pCR and no pCR in the general population (1.132 ± 0.191 × 10(-3) mm(2)/s vs. 1.092 ± 0.189 × 10(-3) mm(2)/s, respectively; P = .23). The optimal ADC cutoff value in the general population was 0.975 × 10(-3) mm(2)/s (receiver operating characteristic [ROC] area under the curve [AUC], 0.587 for the prediction of a pCR). After splitting the population into subgroups according to tumor phenotype, we observed a significant or nearly significant difference in the mean ADC value among the responders versus the nonresponders in the TN (P = .06) and HER2(+) subgroups (P = .05). No meaningful difference was seen in the luminal and hybrid subgroups (P = .59 and P = .53, respectively). In contrast, in the TN and HER2(+) subgroups (cutoff value, 0.995 × 10(-3) mm(2)/s and 0.971 × 10(-3) mm(2)/s, respectively), we observed adequate ROC AUCs (0.766 and 0.813, respectively)., Conclusion: The pretreatment ADC value is not capable of predicting the pCR in the overall population of patients with locally advanced breast cancer. Nonetheless, an ameliorated diagnostic performance was observed in specific phenotype subgroups (ie, TN and HER2(+) tumors)., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to describe the ultrasonographic (US) and mammographic (MX) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in the surgical cavity and their size variations in follow-up., Materials and Methods: We retrospectively reviewed 417 MX and 743 US images performed between January 2009 and January 2014 for 262 women who underwent breast-conserving surgery. All patients underwent US, only 203 women underwent MX examination., Results: In 170 of 262 patients, US examinations showed abnormal findings. Three main US patterns were identified: (1) complex masses: well-encapsulated ipoisoechoic lesions with circumscribed margins with internal hyperechoic nodules (56%); (2) hypoanechoic lesions without internal hyperechoic nodules (24%); and (3) completely anechoic collections (20%). Moreover, Doppler ultrasound examination was performed on all of the patients. In 95 of 203 patients, MX examinations showed abnormalities. Four main MX patterns were identified: (1) round or oval opacity with circumscribed margins (58%); (2) round or oval opacity with indistinct or ill-defined margins (17%); (3) irregular opacity with indistinct or spiculated margins (9%); and (4) architectural distortion or focal asymmetry (15%). Most of the lesions showed a decrease in size at US and MX follow-up examination and the decrease was statistically significant (P < .01)., Conclusion: When applied to the surgical residual cavity, ORC aids to control local hemorrhage and reduce the risk of postoperative infections, but can lead to alterations in surgical scar. Thus, knowledge of the radiological findings might allow avoidance of misdiagnosis of tumor recurrence or unnecessary diagnostic examinations., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: This study was done to investigate the correlation between the apparent diffusion coefficient (ADC) and prognostic factors of breast cancer., Materials and Methods: From January 2008 to June 2011, all consecutive patients with breast cancer who underwent breast magnetic resonance imaging (MRI) and subsequent surgery in our hospital were enrolled in our study. The MRI protocol included a diffusion-weighted imaging sequence with b values of 0 and 1,000 s/mm(2). For each target lesion in the breast, the ADC value was compared with regard to major prognostic factors: histology, tumour grade, tumour size, lymph node status, and age., Results: A total of 289 patients with a mean age of 53.49 years were included in the study. The mean ADC value of malignant lesions was 1.02 × 10(-3) mm(2)/s. In situ carcinomas, grade 1 lesions, and tumours without lymph nodal involvement had mean ADC values that were significantly higher than those of invasive carcinomas (p = 0.009), grade 2/3 lesions (p < 0.001), and tumours with nodal metastases (p = 0.001). No significant differences were observed in ADC values among tumours of different sizes or among patient age groups., Conclusions: ADC values appear to correlate with tumour grade and some major prognostic factors.