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Current approaches to breast cancer therapy include neoadjuvant systemic therapy (NST). The efficacy of NST is measured by pathologic complete response (pCR). A patient who attains pCR has significantly enhanced disease-free survival progress. The accurate prediction of pCR in response to a given treatment regimen could increase the likelihood of achieving pCR and prevent toxicities caused by treatments that are not effective. Th early prediction of response to NST can increase the likelihood of survival and help with decisions regarding breast-conserving surgery. An automated NST prediction framework that is able to precisely predict which patient undergoing NST will achieve a pathological complete response (pCR) at an early stage of treatment is needed. Here, we propose an end-to-end efficient multimodal spatiotemporal deep learning framework (deep-NST) framework to predict the outcome of NST prior or at an early stage of treatment. The deep-NST model incorporates imaging data captured at different timestamps of NST regimens, a tumor’s molecular data, and a patient’s demographic data. The efficacy of the proposed work is validated on the publicly available ISPY-1 dataset, in terms of accuracy, area under the curve (AUC), and computational complexity. In addition, seven ablation experiments were carried out to evaluate the impact of each design module in the proposed work. The experimental results show that the proposed framework performs significantly better than other recent methods.

The presence of mammographically evident hyperdense foci within axillary lymph nodes elicits concern for calcium deposits, which in turn have a wide differential diagnosis including both benign and malignant entities. Tissue sampling, most commonly by way of image-guided core needle biopsy, is needed in many cases when a definite etiology cannot be clinically established. In this case series we present history, imaging findings, and pathology results (or long term follow-up stability as biopsy surrogate) of several women with body tattoos who at mammography were noted to have a characteristic pattern of “bubbly” pseudo-calcifications within axillary lymph nodes, and absence of other mammographic, sonographic and clinical abnormalities.

In 2016, the World Health Organization added Breast Implant-Associated Anaplastic Large Cell lymphoma as a provisionally recognized lymphoma to the family of existing Anaplastic Large Cell lymphomas. Current estimates of the lifetime risk of the disease in women with textured breast implants range from 1:1,000 to 1:30,000. The mean interval from implant placement to diagnosis is 10.7 ± 4.6 years and the most common clinical symptom at presentation is breast swelling. A high level of clinical suspicion is recommended in patients presenting with breast symptoms and/or peri-implant fluid collection occurring more than 1 year after breast implant placement. Ultrasound is the imaging modality of choice, with a high sensitivity for peri-implant fluid and a high specificity for peri-implant mass. When ultrasound is inconclusive, breast MRI is indicated. As of today, all confirmed cases have tested positive for CD30 immunohistochemistry and the disease has shown to have an excellent prognosis when it is diagnosed earlier (localized disease), and when complete surgery, consisting of explantation, capsulectomy, and removal of any associated capsule mass, is performed. This overview summarizes the available epidemiological and clinical data of Breast Implant-Associated Anaplastic Large Cell lymphoma, with an emphasis on imaging features.

Objective To explore current practice patterns of reporting and issuing recommendations based on the presence of breast arterial calcifications on mammography and existing knowledge of their prevalence and associated factors. Methods An online anonymous 19-question survey was distributed to 2583 practicing radiologists who were members of the Society of Breast Imaging. Questions covered demographics, breast imaging training, practice type, and knowledge regarding the epidemiology and potential clinical significance of breast arterial calcifications detected on mammograms. Differences between groups were calculated using the chi-square test or Fisher exact test. An α level of 0.05 was used to determine statistical significance. Results Response rate was 22% (364/1662). The median age of respondents was 51 years (range: 29–76) and most were female (248/323, 77%). The most prevalent characteristics among respondents were as follows: 69% (223/323) had completed a breast imaging fellowship, 55% (179/323) were in private practice, 49% (158/323) practiced dedicated breast imaging, and 38% (124/323) had been in practice for more than 20 years. The prevalence of breast arterial calcifications was correctly estimated to be 1%–30% by 39% (125/323) of respondents. Most respondents correctly recognized the growing evidence of an association between breast arterial calcifications and coronary artery disease (275/323, 85%). However, only 15% (48/323) always reported the presence of these calcifications, and of those who report them at any time, only 0.7% (2/274) always issued recommendations. Conclusion There are differences in both knowledge of the epidemiology of breast arterial calcifications and practices around their reporting amongst breast radiologists.

Breast implant-associated anaplastic large cell lymphoma is a rare disease first described in 1997. Since then, its incidence has continued to increase. Current estimated lifetime risk in women with textured breast implants range from 1:1000 to 1:30,000. Most cases present with rapid and dramatic breast swelling resulting from peri-implant fluid collection. Palpable mass, pain, and skin lesions also occur. A high index of suspicion in patients who develop a seroma around the breast implant more than one year after implant placement is required. The combination of clinical history, physical exam findings, and appropriate imaging workup can lead to a timely and accurate diagnosis. The disease has excellent prognosis when it is diagnosed earlier, and complete surgery is performed. Radiologists, particularly those involved in breast imaging, can play an essential role in early diagnosis. This chapter presents an overview of the disease, including relevant imaging findings.

Antiestrogen mediated cell cycle arrest requires the CDK inhibitor, p27. Src kinase mediates p27 loss and antiestrogen resistance in ER+ breast cancer lines in vitro. In ER+ xenografts, the Src inhibitor, saracatinib, restored antiestrogen responses in resistant tumors. This led to a Phase I/randomized double-blind Phase II trial to test effects of saracatinib with anastrozole for ER+ and/or PR+ postmenopausal breast cancer. Phase I accrued 12 subjects and showed 175 mg po saracatinib is safely given with 1 mg po daily anastrozole with good PK . In Phase II, postmenopausal women with new ER+ and/or PR+, HER2- breast cancers ≥ 2 cm were randomized 2:1 to either neoadjuvant anastrozole with saracatinib or anastrozole/placebo over 6 months. Response was assayed by clinical 2D measurements each cycle and by MRI pre-study, at 10 weeks and prior to surgery. The Phase II primary endpoint was to test if tumor volume decrease (from 2D clinical measures) with dual therapy (dual) exceeded that of monotherapy (mono) by >20%. Secondary endpoints included tumor response by 3D MRI measures and by RECIST, PK and toxicity, and molecular predictors of drug efficacy in pre-/ post-therapy tumors. Of 58 subjects, 15% were Black, 5% Asian and 79% White. 61% were Hispanic. Dual therapy was well tolerated, with the following grade 1 toxicities: flu-like syndrome 20%, non-pruritic rash 48% (17% for mono), self-limited diarrhea in 55% (33% mono). Transaminasemia with dual therapy was 52.5% and 17% with mono. 6/59 stopped dual due to drug related AEs: 2 had gr 3 hepatitis, one gr 3 anemia, 3 had grade 3 urticarial rash. Dual Rx increased mean anastrozole levels to 50 ng/ml vs 38 ng/ml for mono (T test p= 5.45201 E-05). Mean saracatinib level, 269 ng/ml, was similar to prior studies. All of 50 evaluable subjects showed clinical and MRI tumor responses. 17% in both groups progressed, usually after 16 weeks. Mean tumor vol (calculated from 2D clinic measures) declined more rapidly (by 63% in dual vs 55% in mono at 8 weeks), but both groups showed an 89% mean tumor volume decrease by 20 weeks. Clinical RECIST showed size reductions of 61% in dual and 62% after monotherapy. Tumor volumes based on 3D MRI show a non-significant trend to greater response to dual therapy, with mean volume decreased by 64% vs 45% at the end of dual vs monotherapy. RECIST response by MRI also showed a trend to greater % decrease tumor size post treatment by 34% vs 25% in dual vs mono. Thus, clinical volumetric assessment of response to this neoadjuvant endocrine therapy may overestimate response compared to volumes calculated by MRI, while RECIST may underestimate it. Pathologic responses based on initial and residual tumor burden calculated from initial and final tumor volumes and % cellularity in biopsy and surgical specimens will be presented. Citation Format: Slingerland JM, Mark P, Hurley J, Net J, Collado-Mesa F, Lippman M, Avisar E, Yepes M, Jorda M, Gomez C. Results of a randomized double blind trial of neoadjuvant anastrozole plus placebo vs anastrozole plus saracatinib for ER+ postmenopausal breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-15-06.

Purpose Advances in artificial intelligence applied to diagnostic radiology are predicted to have a major impact on this medical specialty. With the goal of establishing a baseline upon which to build educational activities on this topic, a survey was conducted among trainees and attending radiologists at a single residency program. Methods An anonymous questionnaire was distributed. Comparisons of categorical data between groups (trainees and attending radiologists) were made using Pearson χ 2 analysis or an exact analysis when required. Comparisons were made using the Wilcoxon rank sum test when the data were not normally distributed. An α level of 0.05 was used. Results The overall response rate was 66% (69 of 104). Thirty-six percent of participants (n = 25) reported not having read a scientific medical article on the topic of artificial intelligence during the past 12 months. Twenty-nine percent of respondents (n = 12) reported using artificial intelligence tools during their daily work. Trainees were more likely to express doubts on whether they would have pursued diagnostic radiology as a career had they known of the potential impact artificial intelligence is predicted to have on the specialty ( P = .0254) and were also more likely to plan to learn about the topic ( P = .0401). Conclusions Radiologists lack exposure to current scientific medical articles on artificial intelligence. Trainees are concerned by the implications artificial intelligence may have on their jobs and desire to learn about the topic. There is a need to develop educational resources to help radiologists assume an active role in guiding and facilitating the development and implementation of artificial intelligence tools in diagnostic radiology.

Medical imaging refers to several different technologies that are used to view the human body to diagnose, monitor, or treat medical conditions. It requires significant expertise to efficiently and correctly interpret the images generated by each of these technologies, which among others include radiography, ultrasound, and magnetic resonance imaging. Deep learning and machine learning techniques provide different solutions for medical image interpretation including those associated with detection and diagnosis. Despite the huge success of deep learning algorithms in image analysis, training algorithms to reach human-level performance in these tasks depends on the availability of large amounts of high-quality training data, including high-quality annotations to serve as ground-truth. Different annotation tools have been developed to assist with the annotation process. In this survey, we present the currently available annotation tools for medical imaging, including descriptions of graphical user interfaces (GUI) and supporting instruments. The main contribution of this study is to provide an intensive review of the popular annotation tools and show their successful usage in annotating medical imaging dataset to guide researchers in this area.

Despite its proven record as a breast cancer screening tool, mammography remains labor-intensive and has recognized limitations, including low sensitivity in women with dense breast tissue. In the last ten years, Neural Network advances have been applied to mammography to help radiologists increase their efficiency and accuracy. This survey aims to present, in an organized and structured manner, the current knowledge base of convolutional neural networks (CNNs) in mammography. The survey first discusses traditional Computer Assisted Detection (CAD) and more recently developed CNN-based models for computer vision in mammography. It then presents and discusses the literature on available mammography training datasets. The survey then presents and discusses current literature on CNNs for four distinct mammography tasks: (1) breast density classification, (2) breast asymmetry detection and classification, (3) calcification detection and classification, and (4) mass detection and classification, including presenting and comparing the reported quantitative results for each task and the pros and cons of the different CNN-based approaches. Then, it offers real-world applications of CNN CAD algorithms by discussing current Food and Drug Administration (FDA) approved models. Finally, this survey highlights the potential opportunities for future work in this field. The material presented and discussed in this survey could serve as a road map for developing CNN-based solutions to improve mammographic detection of breast cancer further.

Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer-related death among American women. Underserved minorities suffer from higher mortality rates and a higher prevalence of triple-negative breast cancer (TNBC). Previous studies showed that African Americans (AA) have a higher risk for TNBC, advanced tumor, pro-inflammatory tumor microenvironment, and worse survival. Immune responses and inflammatory processes play critical roles in cancer initiation, progression, and suppression. Therefore, this study was designed to investigate the complex interplay among the tumor, microenvironment, and immune response by race and TNBC status. Tumor biopsy samples from 96 breast cancer cases were used for the NanoString PanCancer IO 360 Gene Expression Panel analysis. The panel is a 770 gene Code Set that is designed for profiling tumor biopsies and characterizing gene expression patterns associated with the tumor, the immune response, and the microenvironment that shape tumor-immune interactions. After quality control for 20 reference genes, gene expression data from 93 samples were used for subsequent data analysis with nSolver 4.0 to calculate expression changes, pathway mapping based on annotations, sample clustering (heat maps), and 14 immune cell type abundance signatures. Then we conducted a Student's t-test and ANOVA for comparison of immune cell types by patient demographics and clinical characteristics using SAS University Edition 2019. In 10 TNBC and 83 non-TNBC, the expression of 12 genes was significantly different, 4 were higher and 8 were lower in TNBC (False Discovery Rate adjusted p Citation Format: Xiaozhuang Hu, Fernando Collado-Mesa, George R. Yang, Isildinha M. Reis, Jennifer J. Hu. Immune-cell profiling in breast cancer patients by race and triple negative breast cancer status [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2725.

BACKGROUND Health care reform in the United States has generated a paradigm shift in the practice of radiology aimed at increasing the degree of patient-centered care. We conducted a study to quantify the amount of time breast imaging radiologists spend on value-added activities at an academic comprehensive cancer center located in Miami, Florida, and accredited by the American College of Radiology as a Breast Imaging Center of Excellence. METHODS A prospective, observational study was conducted during a period of 20 consecutive workdays. Three participating breast imaging radiologists maintained a real-time log of each activity performed. A generalized linear model was used to perform a 1-way analysis of variance. An alpha level of .05 was used to determine statistical significance. RESULTS The average daily time dedicated to these activities was 92.1 minutes (range, 56.4-132.2). The amount of time significantly differed among breast imaging radiologists and correlated with their assigned daily role (P < .001 for both) but was independent of their years of experience. The daily role that required the most time was the interpretation of diagnostic imaging studies, which is when most interactions with patients, their relatives, and referring physicians occurred. The specific activity that required the most time was preparing for and participating in tumor boards. CONCLUSIONS Our findings suggest that the breast imaging radiologists who participated in this study dedicated a significant amount of their time to value-added activities to help improve patients' experience across the continuity of their care. We propose that similar studies be conducted at other institutions to better assess the magnitude of this finding across different breast imaging care settings.

Neuroendocrine tumors of the breast are very rare accounting for less than 0.1% of all breast cancers and less than 1% of all neuroendocrine tumors. Focal neuroendocrine differentiation can be found in different histologic types of breast carcinoma including in situ and invasive ductal or invasive lobular. However, primary neuroendocrine carcinoma of the breast requires the expression of neuroendocrine markers in more than 50% of the cell population, the presence of ductal carcinoma in situ, and the absence of clinical evidence of concurrent primary neuroendocrine carcinoma of any other organ. Reports discussing the imaging characteristics of this rare carcinoma in different breast imaging modalities are scarce. We present 2 cases of primary neuroendocrine carcinoma of the breast for which mammography, ultrasound, and magnetic resonance imaging findings and pathology findings are described. A review of the medical literature on this particular topic was performed, and the results are presented.

Objective: To assess the results of an initial round of supplemental screening with hand-held bilateral breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue who are not at high risk for breast cancer. Materials and Methods: A retrospective, Health Insurance Portability and Accountability Act compliant, Institutional Research Board approved study was performed at a single academic tertiary breast center. Informed consent was waived. A systematic review of the breast imaging center database was conducted to identify and retrieve data for all asymptomatic women, who were found to have heterogeneously dense or extremely dense breast tissue on screening bilateral mammograms performed from July 1, 2010 through June 30, 2012 and who received a mammographic final assessment American College of Radiology's (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 1 or BI-RADS category 2. Hand-held screening ultrasound was performed initially by a technologist followed by a radiologist. Chi-square and t-test were used and statistical significance was considered at P< 0.05. Results: A total of 1210 women were identified. Of these, 394 underwent the offered supplemental screening ultrasound. BI-RADS category 1 or 2 was assigned to 323 women (81.9%). BI-RADS category 3 was assigned to 50 women (12.9%). A total of 26 biopsies/aspirations were recommended and performed in 26 women (6.6%). The most common finding for which biopsy was recommended was a solid mass (88.5%) with an average size of 0.9 cm (0.5–1.7 cm). Most frequent pathology result was fibroadenoma (60.8%). No carcinoma was found. Conclusion: Our data support the reported occurrence of a relatively high number of false positives at supplemental screening with breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue, who are not at a high risk of developing breast cancer, and suggests that caution is necessary in establishing wide implementation of this type of supplemental screening for all women with dense breast tissue without considering other risk factors for breast cancer.

To assess whether the application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy decreases pain at the site of the initial injection.In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study, 50 women aged 49.1 ± 1.6 years (mean ± standard error) were recruited and provided written informed consent. Participants served as their own controls and were blinded as to whether a topical vapocoolant spray or a placebo was used immediately prior to the initial local anaesthetic injection at two separate biopsy sites. With the exception of the application of vapocoolant or placebo, the entire ultrasound-guided procedure was performed according to a routine protocol. Participants recorded pain at initial injection site on a visual analogue scale. General linear mixed models for repeated measures analysis of variance and a 0.05 significance level were used.Application of topical vapocoolant spray was shown to significantly decrease pain at the site of initial intradermal anaesthetic injection as compared to placebo (p0.001). Treatment effect was independent of age of the subject, race/ethnicity, operator, type of biopsy device, and histopathology result. No complications from vapocoolant spray use were reported.Application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy significantly decreases pain at the site of the initial injection and could contribute to improve the patient's overall procedural experience.

OBJECTIVE: To explore, for Latin America, by means of an ecological correlation analysis, the possible relationships between both the incidence and prevalence of childhood type 1 diabetes and selected hypothesized etiological factors, including race/ethnicity, geographical latitude, breast-feeding rates, per capita milk supply and coffee consumption, and wealth-related indicators such as infant mortality rate, life expectancy at birth, and national human development index. METHODS: Recently published data on incidence and prevalence of type 1 diabetes in children ¾ 14 years of age in Latin American countries were utilized. Risk indicators were selected based on existing genetic and environmental hypotheses. Indicator data were obtained from publicly available resources. Spearman correlation coefficients were used to measure the association between both incidence and prevalence of type 1 diabetes and the selected indicators. RESULTS: A strong negative correlation was found between the proportion of Amerindians in a country's population and both incidence (r = ­0.75; P= 0.008) and estimated prevalence (r = ­0.78; P< 0.0001) of childhood type 1 diabetes. The per capita supply of milk showed a strong positive correlation with both incidence (r = 0.70; P= 0.025) and prevalence (r = 0.55; P= 0.018). Wealth-related indicators correlated with prevalence but not with incidence. CONCLUSIONS: Our results suggest that the presence of the Amerindian component of the population in Latin America provides protection against childhood-onset type 1 diabetes. Our results also confirm the association previously reported in other countries and regions of the world of type 1 diabetes and milk consumption. Further studies are needed to develop and test potential genetic and environmental hypotheses that could help to better understand the interplay between genetic susceptibility and environment in type 1 diabetes across different ethnic groups.OBJETIVO: Explorar para América Latina, mediante un análisis de correlación ecológico, las posibles relaciones entre tanto la incidencia como la prevalencia de diabetes sacarina tipo 1 con inicio en la niñez y algunos factores etiológicos hipotéticos, entre ellos la raza o etnia, la latitud geográfica, las tasas de lactancia materna, el abastecimiento de leche, el consumo de café per cápita y algunos indicadores de situación económica, tales como la tasa de mortalidad de menores de un año, la esperanza de vida al nacer y el índice nacional de desarrollo humano. MÉTODOS: Se usaron datos publicados recientemente acerca de la incidencia y prevalencia de diabetes tipo 1 en niños menores de 15 años en países latinoamericanos. Se escogieron los indicadores de riesgo en función de las hipótesis de carácter genético y ambiental que se contemplan actualmente. Los datos acerca de los indicadores se obtuvieron de fuentes públicas. Se emplearon coeficientes de correlación de Pearson para medir la asociación entre tanto la incidencia como la prevalencia de diabetes tipo 1 y los indicadores elegidos. RESULTADOS: Se detectó una fuerte correlación inversa entre la proporción de amerindios en la población de un país y la incidencia (r = ­0,75; P = 0,008) y prevalencia estimada (r = 0,55; P = 0,018) de diabetes tipo 1 de aparición en la niñez. El abastecimiento de leche per cápita mostró una fuerte correlación directa con la incidencia (r = 0,70; P = 0,025) y la prevalencia (r = 0,55; P = 0,018) de diabetes. Los indicadores de situación económica mostraron correlación con la prevalencia pero no con la incidencia. CONCLUSIONES: Según nuestros resultados, la presencia del componente amerindio en la población de América Latina protege contra la diabetes tipo 1 con incio en la niñez. Nuestros resultados también confirman la asociación notificada anteriormente en otros países y partes del mundo entre la diabetes tipo 1 y el consumo de leche. Se necesitan más estudios para formular y poner a prueba nuevas hipótesis de orden genético y ambiental que ayuden a entender mejor la interacción entre la susceptibilidad genética y factores ambientales en la aparición de diabetes tipo 1 en distintos grupos étnicos.

Se ha planteado que la enfermedad de Parkinson idiopática y el hábito de fumar tienen una relación inversa, donde el segundo se considera un factor "protector". Se realizó un estudio caso-control no pareado, en personas mayores de 50 años, para comprobar lo anteriormente planteado. El tamaño de muestra necesario se halló mediante el programa Epi Info versión 6.0, Statcalc, que determinó con una relación casos/controles de 1:4, que el tamaño de muestra mínimo debía ser de 68/272. Se analizó la variable hábito de fumar cigarros, la cual se dividió en no fumadores, fumadores y exfumadores. Se comprobó que la relación entre no fumadores y fumadores presentó una OR 3,34 (IC 1,36 - 8,88), con significación estadística, p < 0,029. El resto de las posibles combinaciones no fueron significativas. Se demostró en nuestro estudio, la relación inversa del hábito de fumar cigarros con la enfermedad de Parkinson idiopática.It has been stated that idiopathic Parkinson’s disease and smoking are inversely related, the second being considered as a "protective" factor. A non-paired case-control study was conducted in persons aged over 50 years to confirm the above-mentioned. To find the required sample size, we used the Epi Info Version 6.0 program, called Statcal, which determined that the necessary sample size should be 68 in 272. This was calculated on the basis of a case-control ratio of 1:4. Cigarette smoking was the analyzed variable that was divided into non-smokers, smokers and former smokers. It was verified that the relationship of non-smoker and smokers showed an RO = 3.34 (CI 1,36-8,88) statistically significant; p< 0,029. The rest of the possible combinations were not significant. Our study demonstrated that cigarette smoking and idiopathic Parkinson’s disease are inversely related.

To determine whether mammographic or sonographic features can predict the Oncotype DX™ recurrence scores (RS) in patients with TI-II, hormone receptor (HR) positive, HER2/neu negative and node negative breast cancers. Institutional board review was obtained and informed consent was waived for this retrospective study. Seventy-eight patients with stage I-II invasive breast cancer that was HR positive, HER2 negative, and lymph node negative for whom mammographic and or sonographic imaging and Oncotype DX™ assay scores were available were included in the study Four breast dedicated radiologists blinded to the RS retrospectively described the lesions according to BI-RADS lexicon descriptors. Multivariable logistic regression was used to test for significant independent predictors of low (18) versus intermediate to high range (≥18). Two imaging features reached statistical significance in predicting low from intermediate or high risk RS: pleomorphic microcalcifications within a mass (P = 0.017); OR 8.37, 95 % CI (1.47-47.79) on mammography and posterior acoustic enhancement in a mass on ultrasound (P = 0.048); OR 4.35, 95 % CI (1.01-18.73) on multivariable logistic regression. A mass with pleomorphic microcalcifications on mammography or the presence of posterior acoustic enhancement on ultrasound may predict an intermediate to high RS as determined by the Oncotype DX(TM) assay in patients with stage I-II HR positive, HER2 negative, and lymph node negative invasive breast cancer.

To assess whether CT attenuation values help in differentiating benign from malignant etiology of focal (18) F-FDG avid breast lesions detected on whole-body PET/CT exam in postoperative breast cancer patients. Institutional review board approval and waived informed consent were obtained for this HIPAA-compliant retrospective study. Between January 2009 and July 2011, a total of 85 patients had 97 focal (18) F-FDG avid breast lesions on whole-body PET/CT. Of these, 54 (56%) lesions were biopsy-proven primary invasive breast carcinoma that had not undergone treatment at the time of PET/CT, 35 (36%) were benign lesions, and 8 were locally recurrent breast carcinoma. Mean attenuation values were retrospectively measured in Hounsfield units (HU) for the correlative lesion on the CT portion of the exam. Receiver-operating characteristic curves (ROC) were calculated to determine the optimal cutoff values of HU that would best discriminate between benign and malignant lesions. Interobserver agreement for measured mean attenuation values was assessed by calculating the intraclass correlation coefficient (ICC). Mean HU for the benign lesions group and the local recurrence lesions group was -11.0 ± 30.3 versus 32.9 ± 6.87 (p

Silicone lymphadenopathy is a recognized complication of silicone gel implant rupture; the ipsilateral axillary lymph nodes are most commonly involved. We report imaging findings on a range of different imaging modalities and biopsy results in a case of biopsy-proven silicone lymphadenitis involving contralateral intramammary and axillary lymph nodes in a patient with an intact standard dual-lumen breast implant in the opposite reconstructed breast. This case demonstrates that in a patient with disrupted lymph drainage due to prior mastectomy and axillary node dissection for breast cancer treatment, silicone particles can migrate in a retrograde fashion via the ipsilateral internal mammary lymph nodes and reach not only the contralateral axilla but also the outer quadrants of the contralateral breast, even in the presence of an intact breast implant.

OBJECTIVE To determine the survival pattern and the underlying cause of death in a cohort of childhood-onset IDDM subjects from Havana City Province, Cuba. RESEARCH DESIGN AND METHODS This was a descriptive study carried out on a historical cohort of IDDM subjects with disease onset before 15 years of age in Havana City Province, Cuba. The cohort was assembled from several sources. Subjects were diagnosed from 1965 to 1980, and their vital status was assessed at 31 December 1991. Cumulative survival rate was calculated by the Kaplan-Meier method, and a univariate analysis was performed. To test survival differences between groups, the Cox-Mantel test was used. To compare the cohort mortality with the general population, standardized mortality ratios by sex and age were calculated. Specific causes of death were determined by a committee examining death certificates, clinical records, and necropsy reports. RESULTS A total of 504 subjects were identified, and the mean follow-up time was 17.5 years. Of the subjects, 70 (13.9%) had died at 31 December 1991. Overall, the cohort had a 71% cumulative survival rate at 25 years of IDDM duration. There were no survival differences according to sex or calendar period of IDDM diagnosis. Statistically significant differences were found among age-at-diagnosis groups. The group with a peripubertal age at diagnosis showed the worst prognosis. The cohort experienced 8.5 times the all-causes death rate, compared with the general population. Renal disease accounted for almost half the deaths. CONCLUSIONS IDDM subjects from Havana City Province, Cuba, showed a better survival pattern than IDDM subjects from other developing countries. However, when compared with IDDM populations from developed countries, there is a survival reserve to be achieved by reducing mortality due to renal disease and infections.

Se realizó un estudio descriptivo, de tipo prospectivo no concurrente, para conocer la mortalidad de pacientes cuyo inicio de la enfermedad ocurre antes de los 15 años de edad con diabetes mellitus insulinodependiente. Fueron identificados, a través de una búsqueda exhaustiva en todas las fuentes posibles, 504 pacientes de Ciudad de La Habana, de 1965 a 1980. Se utilizó el método de personas-años. El status que presentaban el 31 de diciembre de 1991 fue de 400 vivos (79,4 %), 70 fallecidos (13,9 %), 23 emigrados (4,6 %) y 11 ilocalizables (2,2 %). El tiempo medio de seguimiento fue de 17,5 años. El 11 % de los pacientes había fallecido antes de los 30 años de edad, la cohorte presentó un exceso significativo de mortalidad de 8,5 veces en relación con la población del país (p < 0,05). Dicho exceso se debió, fundamentalmente, a las enfermedades renales, responsables del 48,6 % de las muertes; en tanto que las complicaciones agudas (cetoacidosis, coma, sepsis e hipoglicemia) aportaron el 25,6 %.

Neurofibromas are slow-growing, painless, benign nerve-sheath tumors. They occur most commonly in the dermis and subcutis and are rarely found in the breast. We report a rare case of a solitary neurofibroma of the breast in a 61-year-old asymptomatic woman.

To examine skin cancer awareness and behavior in white Hispanic (WH) and white non-Hispanic (WNH) high school students because increasing incidence and delayed diagnosis of skin cancer in the growing Hispanic population in the United States represent an emerging health issue.Pilot survey study.A high school in Miami, Florida.A total of 369 high school students (221 WHs and 148 WNHs) were surveyed in the study.Survey data were collected regarding skin cancer knowledge, perceived risk, and sun protection behaviors. Differences between the 2 groups were compared with chi(2) tests.White Hispanic students were more likely to tan deeply (P = .04) but less likely to have heard of (P.01) or been told how to perform (P.01) skin self-examination. White Hispanics were less likely to wear sun-protective clothing or to use sunscreen with a sun protection factor of 15 or higher and reported a greater use of tanning beds. White Hispanic students also thought their chance of developing skin cancer was less than that of WNH students (P.01), which remained significant after adjustment for age, sex, family history, and skin sensitivity to sun. After adjustment, WHs were 2.5 times more likely than WNHs to have used a tanning bed in the past year. White Hispanics were also 60% less likely to have heard of skin self-examination (P.01) and 70% less likely than WNHs to have ever been told to perform the examination (P = .03). White Hispanics are about 1.8 and 2 times more likely to never or rarely wear protective clothing (P.01) and to use sunscreen (P = .01), respectively.There are disparities in knowledge, perceived risk of skin cancer, and sun-protective behaviors among WH and WNH high school students.

In order to estimate the prevalence of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) co-infection in hard-to-reach intravenous drug users, 199 subjects from high-risk inner-city locales, the so called "shooting galleries", were consented, interviewed, and tested in Miami, FL, US. Positive HIV-1 status was based on repeatedly reactive ELISA and confirmatory Western Blot. Positive HCV status was based on reactive ELISA and confirmatory polymerase chain reaction techniques. Overall, 50 (25%) were not infected with either virus, 61 (31%) were HIV-1/HCV co-infected, 17 (8%) infected by HIV-1 only, and 71 (36%) infected by HCV only. The results of the multivariable analyses showed that more years using heroin was the only significant risk factor for HCV only infection (odds ratio = 1.15; 95% confidence interval = 1.07, 1.24) and for HIV-1/HCV co-infection (odds ratio = 1.17; 95% confidence interval = 1.09, 1.26). This paper demonstrates that HIV-1/HCV co-infection is highly prevalent among so called "shooting galleries".

Little information exists on the epidemiology of melanoma and the role of solar radiation in the development of melanoma in pigmented populations.To evaluate the relationship between exposure to solar radiation and the incidence of melanoma in US Hispanics and blacks.Population-based ecological study.State cancer registries of New York, New Jersey, Illinois, California, Texas, and Florida. Subjects Patients with invasive melanoma recorded by cancer registries.We obtained age-adjusted, race/ethnicity- and sex-specific incidence rates of melanoma from similar time periods from the 6 cancer registries. The incidence rates were correlated with the annual mean UV index and the latitude of residency.For both Hispanics and blacks, the incidence of melanoma was positively associated with the UV index and negatively associated with the latitude of residency. Statistically significant correlation between melanoma and the UV index (R = 0.93; P =.01) and latitude (R = -0.80; P =.05) was observed in black males. Hispanics and blacks have a significantly lower incidence of melanoma than whites, with blacks having the lowest rates of melanoma.Exposure to solar radiation appears to play a role in the development of melanoma in both Hispanics and blacks. Sun protection and melanoma risk education should be performed in these populations.

OBJECTIVE: Earlier studies by this research team found that medically underserved minority women in the Miami-Dade County area of the state of Florida, United States, were in need of breast cancer screening and that there were problems with availability, accessibility, and acceptability of services. In response, a community-based comprehensive breast cancer screening program called the Early Detection Program (EDP) was developed. The specific purpose of this study was to assess the effect that EDP participation had on stage at diagnosis and on hazard of death. METHODS: Existing data from the Florida Cancer Data System (FCDS), a statewide cancer registry, were linked with data from the EDP. In December 1998 we assembled a multiethnic (African-American, black Hispanic, white Hispanic, and white non-Hispanic) retrospective cohort with the following inclusion criteria: all women aged 40 and older with breast cancer diagnosed and staged at University of Miami/Jackson Memorial Medical Center (which is located in the city of Miami, Florida) from January 1987 through December 1997. EDP participants were medically underserved, that is, they resided in lower socioeconomic areas and/or had limited or no health insurance to cover medical costs. Subjects identified as EDP participants were compared to nonparticipants with respect to disease stage at diagnosis and hazard of death. Logistic regression and Cox regression models were used for analysis. RESULTS: EDP participants were 2.4 times as likely (95% confidence interval = 1.71 to 3.43) to present with a diagnosis of localized cancer as were nonparticipants, even after controlling for race and age at diagnosis. EDP participation was independently associated with both earlier diagnosis and reduced hazard of death. CONCLUSIONS: Participation in the EDP increases the likelihood of early detection of breast cancer and reduces the hazard of death for medically underserved women in the Miami-Dade County area of Florida. Interestingly, white Hispanics showed a better survival than did both African-Americans and white non-Hispanics. Our research also demonstrates the value of utilizing existing cancer registry data to evaluate a community-based program such as the EDP.

Non-Hodgkin’s lymphoma (NHL) is one of the most common cancers among American Hispanics. Several studies suggest that solar UV radiation (UVR) may be an environmental risk contributing to the rise of NHL over the past decades. These studies focused primarily on light-skinned Caucasian populations; it is unknown what role UVR plays in NHL for Hispanics. We described the incidence of NHL in Hispanics from selected states in the United States between 1989 and 2000. To evaluate the role of UVR, we correlated cancer rates with the UV index and latitude of residency. Variations in NHL incidence rates with estimated amount of UVR among whites and blacks from the selected states were also analyzed. We found that NHL occurred less frequently in Hispanics than in whites. Hispanic men had higher incidence of NHL than Hispanic women. Incidence rates of NHL in Hispanics were inversely associated with estimated amount of UVR as an increase in NHL was observed with decreasing UV index (r = −0.7 in men; r = −0.41 in women) or increasing latitude of residency (r = 0.59 in men; r = 0.48 in women). This trend, although it did not reach statistical significance, was also observed in whites and blacks. Our findings do not support previous reports of a positive association between solar radiation and NHL. The inverse relationship between UVR and incidence of NHL is unexplained but presents the need for generation of hypotheses regarding the epidemiology of causal factors for NHL in the United States. Additional studies should be conducted to clarify whether sunlight exposure contributes to the development of NHL.

In order to estimate the prevalence of serological markers of exposure to Hepatitis B Virus (HBV), 295 subjects were selected at random from the National Registry of human immunodeficiency virus positive subjects. Evidence of exposure to HBV was defined as: testing Hepatitis B surface antigen (HBsAg) and anti-Hepatitis B core antigen (anti-HBc) positive or anti-HBc positive only. Overall, 133 (45.5%) were positive for anti-HBc and 15 (5.1%) resulted positive to HBsAg. Significant statistical association was found between male sex and exposure to HBV (p

It has been suggested that breastfeeding is a protective factor against Type 1 DM due to anti-infection properties or delay in exposure to other agents in the diet. A descriptive study was carried out using data from the Cuban National Registry of Childhood-Onset Diabetes Mellitus (CNRDM). The goal of the study was to determine the frequency and duration of breast-feeding in Cuban children with Type 1 DM. Four hundred and eighty-six children were registered in the CNRDM between January 1, 1988, and December 31, 1993. Breast-feeding data was obtained from two hundred and sixty three (54.1%) of the total registered children. Of these children, two hundred and one (76.4%) were breastfed. The median duration of breast-feeding was three months (Total range 144 months). No statistically significant association was found between the mean age at DM or the clinical profile at diagnosis and the breast-feeding duration groups (p >0.05, respectively). In conclusion, Cuban children with Type 1 DM have relatively low frequency of breast-feeding. When breast-feeding is studied without stratifying for different types of breast-feeding (e.g. exclusive and non-exclusive), there is no association found with the age at DM diagnosis or the clinical profiles at diagnosis. Há evidências de que o aleitamento materno age como um fator protetor contra o DM Tipo 1 devido a propriedades antiinfecciosas ou porque retarda a exposição a outros agentes na dieta. Foi realizado um estudo descritivo com dados do Registro Nacional Cubanas de Diabetes Mellitus na Infância (CNRDM). O objetivo desse estudo era determinar a freqüência e duração do aleitamento materno em crianças cubanas com DM Tipo 1. Quatrocentas e oitenta e seis crianças foram cadastradas no CNRDM entre 1 de janeiro de 1988 e 31 de dezembro de 1993. Os dados sobre aleitamento materno foram obtidos de duzentas e sessenta e três crianças (54.1%) do total registrado. Dessas crianças, duzentas e uma (76.4%) foram amamentadas. A duração média do aleitamento materno foi de (3) meses (Variação total entre 1 e 44 meses). Não foi encontrada nenhuma diferença estatisticamente significante entre a idade média de início e os grupos de duração do aleitamento materno (p >0.05). Concluindo, as crianças cubanas com DM Tipo 1 apresentam uma freqüência relativamente baixa tanto do aleitamento materno exclusivo como não exclusivo. Quando o aleitamento materno é estudado sem estratificação em diferentes tipos (ex. exclusivo e não exclusivo), não encontra-se associação com a idade ou perfil clínico no momento do diagnóstico.