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Hintergrund Radiologische Untersuchungen nicht nur als bloße Bilder, sondern als Datenquelle zu betrachten, ist zum modernen Paradigma der diagnostischen Bildgebung geworden. Dieser Perspektivwechsel hat sich besonders in der Brustbildgebung durchgesetzt, ermöglicht er doch, aus der Informatik abgeleitete Verfahren anzuwenden, innovative klinische Anwendungen zu realisieren und bereits etablierte Methoden zu verfeinern. In diesem Zusammenhang sind die Begriffe „bildgebender Biomarker“, „Radiomics“ und „künstliche Intelligenz“ von zentraler Bedeutung. Diese Methoden versprechen nichtinvasive, kostengünstige (z. B. im Vergleich zu Multigen-Arrays), workflow-freundliche (automatisiert, nur eine Untersuchung, sofortige Ergebnisse) und klinisch relevante Informationen. Methoden und Ergebnisse Dieser Artikel wurde als narratives Review zu dem besagten Paradigma im Bereich der Brustbildgebung konzipiert. Der Schwerpunkt liegt auf den Schlüsselkonzepten und wichtigen Schlagworten. Für alle Bereiche der Brustbildgebung werden beispielhafte Studien diskutiert. Schlussfolgerung Die Interpretation von radiologischen Untersuchungen als Datenquelle verspricht eine Optimierung der Behandlung von Brustkrebspatientinnen im Zeitalter der Präzisionsmedizin, weil damit die Diagnose verfeinert und eine individualisierte Behandlung erreicht werden könnte. Kernaussagen

Aktuell ist die Kombination aus Mammographie und Sonographie der Goldstandard in der Mammadiagnostik. Bei bestehenden Unklarheiten konnen weiterfuhrende Untersuchungen, wie eine Brust-Magnetresonanztomographie (MRT) und in Studien auch computertomographische Verfahren, zum Einsatz kommen. Die Untersuchungen werden raumlich und zeitlich unabhangig voneinander durchgefuhrt. Die Kombination verschiedener bildgebender Verfahren in Fusionsgeraten verspricht eine deutliche Verbesserung der Brustdiagnostik. Ein Vorteil der Fusionsbildgebung ist, dass durch eine simultane Aufnahme verschiedener Bildmodalitaten bei fixierter Brust eine bessere raumliche Lokalisierbarkeit der „region of interest“ (ROI) erreicht werden kann. Ebenfalls konnen hierdurch sowohl eine Reduktion des Zeit- und Untersucheraufwands als auch ein Ausgleich der Schwachen einer Bildgebung durch die Starken einer zweiten Bildgebung erreicht werden. Diese Arbeit liefert einen Uberblick uber den aktuellen Stand der Forschung und die Historie der Fusion von Ultraschall und Mammographie in der Mammadiagnostik.

Die Entwicklung neuer bildgebender Technologien bleibt eine echte Herausforderung. Die letzten Entwicklungen sind intelligente Innovationen, die auf Technologien aufbauen, die seit Jahrzehnten im Einsatz sind. Man kann das Rad nicht neu erfinden. Aber man kann mit der Optimierung vorhandener Technologien starten, indem man bei erkannten Schwachstellen ansetzt. Fusionstechnologien sind ebenso vielversprechend wie Anwendung kunstlicher Intelligenz. Jedes bildgebende Verfahren muss ebenso seine Zuverlassigkeit und Stabilitat beweisen wie auch seine Effektivitat und Effizienz. Es muss einen einfachen Zugang zu dem Verfahren geben. Der erwartete Vorteil muss potenzielle Nachteile bei weitem uberwiegen. Und ein Gesundheitssystem muss sich das Verfahren leisten konnen. Es gibt noch keine bahnbrechende neue Technologie am Horizont. Aber, wenn jemand eine Idee hat, bitte melden!

Dynamic contrast-enhanced imaging of the initial (IP) and delayed phase (DP) is an integral part of any clinical breast MRI protocol. Furthermore, DWI is increasingly used as an add-on sequence by the breast-imaging community. We investigated whether DWI could be used as a substitute DP. One hundred thirty-two consecutive patients with equivocal or suspicious findings at ultrasound and/or mammography received a full diagnostic breast MRI according to international recommendations. Histopathological verification served as reference standard. We evaluated three sections of the MRI protocol: IP, DP, and apparent diffusion coefficient (ADC) maps derived from DWI. Circular ROIs (regions of interest, mean size 5–10 mm2) were drawn into the enhancing parts of the lesion (first postcontrast). ROIs were transferred to the corresponding location on ADC maps and IP and DP images. Mean ROI values were investigated signal intensity (SI): (1) Initial-phase enhancement = (SI(IP) − SI(precontrast))/SI(precontrast); (2) Delayed-phase enhancement = (SI(DP) − SI(IP))/SI(IP); (3) ADC. Multiparametric combinations were computed using logistic regression analysis: (1) IP+: Initial-phase enhancement and ADC; (2) Curve: Initial-phase enhancement and delayed-phase enhancement; (3) Curve+: Curve and ADC. The diagnostic performances of these feature combinations to diagnose malignancy were compared by the area under the receiver-operating characteristics curve (AUC). One hundred thirty-two patients (age: mean = 57.1 years, range 23–83 years) with 145 lesions were included (malignant/benign 101/44). IP+ (AUC = 0.877) outperformed Curve (AUC = 0.788, p = 0.03). Curve+ was not superior to IP+ (p = 1). DWI could substitute DP. Because DWI is typically used as an add-on to IP and DP, our results might help to abbreviate and to simplify current practice of breast MRI. • DWI provides similar but superior diagnostic information for diagnosis of malignancy in enhancing breast lesions compared to DP. • Adding DP to DWI does not provide incremental information to distinguish benign from malignant lesions. • DWI could substitute DP. As DWI is typically used as an add-on to IP and DP, our findings might help to abbreviate and to simplify current breast MRI practice.

Purpose Mammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients. Methods A total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status. Results After median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS (p = 0.46, likelihood ratio test (LRT)) or OS (p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect. Conclusions Although MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC., Highlights • Mammographic density (MD) is one of the strongest risk factors for breast cancer (BC). • Results from a large BC cohort on the impact of percentage MD (PMD) on prognosis. • No association between PMD with disease-free and overall survival was found. • Risk stratification based on PMD seems not feasible for clinical routine.

Considering radiological examinations not as mere images, but as a source of data, has become the key paradigm in the diagnostic imaging field. This change of perspective is particularly popular in breast imaging. It allows breast radiologists to apply algorithms derived from computer science, to realize innovative clinical applications, and to refine already established methods. In this context, the terminology "imaging biomarker", "radiomics", and "artificial intelligence" are of pivotal importance. These methods promise noninvasive, low-cost (e. g., in comparison to multigene arrays), and workflow-friendly (automated, only one examination, instantaneous results, etc.) delivery of clinically relevant information. This paper is designed as a narrative review on the previously mentioned paradigm. The focus is on key concepts in breast imaging and important buzzwords are explained. For all areas of breast imaging, exemplary studies and potential clinical use cases are discussed. Considering radiological examination as a source of data may optimize patient management by guiding individualized breast cancer diagnosis and oncologic treatment in the age of precision medicine. · In conventional breast imaging, examinations are interpreted based on patterns perceivable by visual inspection.. · The radiomics paradigm treats breast images as a source of data, containing information beyond what is visible to our eyes.. · This results in radiomic signatures that may be considered as imaging biomarkers, as they provide diagnostic, predictive, and prognostic information.. · Radiomics derived imaging biomarkers may be used to individualize breast cancer treatment in the era of precision medicine.. · The concept and key research of radiomics in the field of breast imaging will be discussed in this narrative review..· Dietzel M, Clauser P, Kapetas P et al. Images Are Data: A Breast Imaging Perspective on a Contemporary Paradigm. Fortschr Röntgenstr 2021; 193: 898 - 908. Radiologische Untersuchungen nicht nur als bloße Bilder, sondern als Datenquelle zu betrachten, ist zum modernen Paradigma der diagnostischen Bildgebung geworden. Dieser Perspektivwechsel hat sich besonders in der Brustbildgebung durchgesetzt, ermöglicht er doch aus der Informatik abgeleitete Verfahren anzuwenden, innovative klinische Anwendungen zu realisieren und bereits etablierte Methoden zu verfeinern. In diesem Zusammenhang sind die Begriffe „bildgebender Biomarker“, „Radiomics“ und „künstliche Intelligenz“ von zentraler Bedeutung. Diese Methoden versprechen nichtinvasive, kostengünstige (z. B. im Vergleich zu Multigen-Arrays), Workflow-freundliche (automatisiert, nur eine Untersuchung, sofortige Ergebnisse) und klinisch relevante Informationen. Dieser Artikel wurde als narratives Review zu dem besagten Paradigma im Bereich der Brustbildgebung konzipiert. Der Schwerpunkt liegt auf den Schlüsselkonzepten und wichtigen Schlagworten. Für alle Bereiche der Brustbildgebung werden beispielhafte Studien diskutiert. Die Interpretation von radiologischen Untersuchungen als Datenquelle verspricht eine Optimierung der Behandlung von Brustkrebspatientinnen im Zeitalter der Präzisionsmedizin, da hiermit die Diagnose verfeinert und eine individualisierte Behandlung erreicht werden könnte. · In der konventionellen Brustbildgebung werden Untersuchungen anhand von visuell erkennbaren Mustern interpretiert.. · Das Radiomics-Paradigma behandelt radiologische Brustuntersuchungen hingegen als abstrakte Datenquelle, in der Informationen zu finden sind, die über visuell erkennbare Muster hinausgehen.. · Derartige radiomische Signaturen können als bildgebende Biomarker angesehen werden, da sie diagnostische, prädiktive und prognostische Informationen liefern.. · Derartige bildgebende Biomarker können im Zeitalter der Präzisionsmedizin zur Individualisierung der Brustkrebsbehandlung eingesetzt werden.. · In diesem narrativen Übersichtsartikel stellen wir das Radiomics-Paradigma auf dem Gebiet der Brustkrebsbildgebung anhand von exemplarischen Literaturbeispielen dar..

Currently, the combination of mammography and sonography is the gold standard in breast diagnostics. If there are any uncertainties, further examinations such as breast magnetic resonance imaging (MRI) and, in studies, computer tomographic procedures can be used. These investigations are carried out separately.The combination of different imaging techniques in fusion devices promises a significant improvement in breast diagnostics. Advantages of the new imaging technique include the simultaneous acquisition of different image modalities with a fixed breast, which allows better spatial localization of the region of interest (ROI). This can also reduce the time and investigator effort and compensate for the weaknesses of one imaging technique with the strengths of a second imaging technique. The current state of research and the history of the fusion of ultrasound and mammography in breast diagnostics are summarized.RADIOLOGISCHE STANDARDVERFAHREN: Aktuell ist die Kombination aus Mammographie und Sonographie der Goldstandard in der Mammadiagnostik. Bei bestehenden Unklarheiten können weiterführende Untersuchungen, wie eine Brust-Magnetresonanztomographie (MRT) und in Studien auch computertomographische Verfahren, zum Einsatz kommen. Die Untersuchungen werden räumlich und zeitlich unabhängig voneinander durchgeführt.Die Kombination verschiedener bildgebender Verfahren in Fusionsgeräten verspricht eine deutliche Verbesserung der Brustdiagnostik. Ein Vorteil der Fusionsbildgebung ist, dass durch eine simultane Aufnahme verschiedener Bildmodalitäten bei fixierter Brust eine bessere räumliche Lokalisierbarkeit der „region of interest“ (ROI) erreicht werden kann. Ebenfalls können hierdurch sowohl eine Reduktion des Zeit- und Untersucheraufwands als auch ein Ausgleich der Schwächen einer Bildgebung durch die Stärken einer zweiten Bildgebung erreicht werden. Diese Arbeit liefert einen Überblick über den aktuellen Stand der Forschung und die Historie der Fusion von Ultraschall und Mammographie in der Mammadiagnostik.

PIWI-like 1 and PIWI-like 2 play a role in stem cell self-renewal, and enhanced expression has been reported for several tumor entities. However, few studies have investigated PIWI-like 1 and PIWI-like 2 expressions in breast cancer subtypes regarding prognosis. Therefore, we examined protein expression in a large consecutive cohort of breast cancer patients and correlated it to breast cancer subtypes and survival outcome. PIWI-like 1 and PIWI-like 2 expressions were evaluated using immunohistochemistry in a cohort of 894 breast cancer patients, of whom 363 were eligible for further analysis. Percentage and intensity of stained tumor cells were analyzed and an immunoreactive score (IRS) was calculated. The interaction of PIWI-like 1 and PIWI-like 2 showed a prognostic effect on survival. For the combination of high PIWI-like 1 and low PIWI-like 2 expressions, adjusted hazard ratios (HRs) were significantly higher with regard to overall survival (OS) (HR 2.92, 95% confidence interval (CI) 1.24, 6.90), disease-free survival (DFS) (HR 3.27, 95% CI 1.48, 7.20), and distant disease-free survival (DDFS) (HR 7.64, 95% CI 2.35, 24.82). Both proteins were significantly associated with molecular-like and PAM50 subgroups. Combining high PIWI-like 1 and low PIWI-like 2 expressions predicted poorer prognosis and both markers were associated with aggressive molecular subtypes.

Background: The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods: The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results: For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion: The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.

To investigate whether automated volumetric radiomic analysis of breast cancer vascularization (VAV) can improve survival prediction in primary breast cancer. 314 consecutive patients with primary invasive breast cancer received standard clinical MRI before the initiation of treatment according to international recommendations. Diagnostic work-up, treatment, and follow-up was done at one tertiary care, academic breast-center (outcome: disease specific survival/DSS vs. disease specific death/DSD). The Nottingham Prognostic Index (NPI) was used as the reference method with which to predict survival of breast cancer. Based on the MRI scans, VAV was accomplished by commercially available, FDA-cleared software. DSD served as endpoint. Integration of VAV into the NPI gave NPIVAV. Prediction of DSD by NPIVAV compared to standard NPI alone was investigated (Cox regression, likelihood-test, predictive accuracy: Harrell’s C, Kaplan Meier statistics and corresponding hazard ratios/HR, confidence intervals/CI). DSD occurred in 35 and DSS in 279 patients. Prognostication of the survival outcome by NPI (Harrell’s C = 75.3%) was enhanced by VAV (NPIVAV: Harrell’s C = 81.0%). Most of all, the NPIVAV identified patients with unfavourable outcome more reliably than NPI alone (hazard ratio/HR = 4.5; confidence interval/CI = 2.14-9.58; P = 0.0001). Automated volumetric radiomic analysis of breast cancer vascularization improved survival prediction in primary breast cancer. Most of all, it optimized the identification of patients at higher risk of an unfavorable outcome. Future studies should integrate MRI as a “gate keeper” in the management of breast cancer patients. Such a “gate keeper” could assist in selecting patients benefitting from more advanced diagnostic procedures (genetic profiling etc.) in order to decide whether are a more aggressive therapy (chemotherapy) is warranted.

Bildgebung spielt eine zentrale Rolle in der Sekundar- und Tertiarpravention von Brustkrebs. Bildgebende Verfahren werden eingesetzt im Screening, zur Abklarung klinischer Auffalligkeiten oder im Screening detektierter Befunde und zur Therapieplanung anhand invasiver, bildgestutzter Biopsien sowie zur Abschatzung der Ausdehnung oder des Ansprechens auf neoadjuvante Therapien und fur praoperative Clip- und Drahtmarkierungen. Auch in der Verlaufsbeobachtung nach abgeschlossener Brustkrebstherapie spielt die Bildgebung eine wesentliche Rolle. Die wichtigsten bildgebenden Verfahren sind nach wie vor Mammographie und Ultraschall. Wahrend Letzterer an einer starken Untersucherabhangigkeit leidet, ist die Sensitivitat der Mammographie im Fall der rontgenologisch dichten Brust eingeschrankt. Sowohl Mammographie als auch Ultraschall in ihrer Basisform bieten keine krankheitsspezifischen Informationen und erfordern so eine invasive Abklarung eines Grosteils der auffalligen Befunde mit letztendlich benigner Diagnose. Aus diesem Grund besteht groses Interesse an der Weiterentwicklung bestehender Verfahren und an der Entwicklung neuer bildgebender Verfahren zur Reduktion falsch-positiver Befunde bei gleichzeitig moglichst verbesserter Tumordetektion. Der vorliegende Ubersichtsartikel adressiert die relevantesten, bereits zur Verfugung stehenden Techniken und ihren potenziellen Nutzen in der Praxis.

Simple Summary GD2 is an antigen that is tumor-specific and can be used as a target for specific immunotherapies. Since the knowledge about GD2 in breast cancer is limited, we analyzed the frequency of GD2 expression in breast cancer using two different staining methods and the impact of GD2 expression on the survival of breast cancer patients. GD2 expression was found in more than 50% of breast cancer cases, with the highest frequency in hormone receptor-positive tumors. GD2 expression was not significantly associated with patient outcome. Unlike previous studies with smaller sample sizes that lacked correlation with clinical data, this study includes a larger cohort and associations with survival data and shows that GD2 is expressed on human breast cancer cells, providing a potential target for immunotherapies (e.g., anti-GD2 antibodies or GD2 CAR T cells), that are currently undergoing clinical testing. Abstract The disialoganglioside GD2 is a tumor-associated antigen that may allow for the application of targeted immunotherapies (anti-GD2 antibodies, GD2 CAR T cells) in patients with neuroblastoma and other solid tumors. We retrospectively investigated GD2 expression in a breast cancer cohort, using immunohistochemistry (IHC) and immunofluorescence (IF) on tissue microarrays (TMAs), and its impact on survival. GD2 expression on IHC (n = 568) and IF (n = 503) was investigated in relation to subtypes and patient outcome. Overall, 50.2% of the 568 IHC-assessed samples and 69.8% of the 503 IF-assessed samples were GD2-positive. The highest proportion of GD2-positive tumors was observed in luminal tumors. Significantly fewer GD2-positive cases were detected in triple-negative breast cancer (TNBC) compared with other subtypes. The proportion of GD2-expressing tumors were significantly lower in HER2-positive breast cancer in comparison with luminal tumors on IF staining (but not IHC). GD2 expression of IHC or IF was not significantly associated with disease-free or overall survival, in either the overall cohort or in individual subtypes. However, GD2 expression can be seen in more than 50% of breast cancer cases, with the highest frequency in hormone receptor-positive tumors. With this high expression frequency, patients with GD2-positive advanced breast cancer of all subtypes may benefit from GD2-targeting immunotherapies, which are currently subject to clinical testing.

Introduction The care of patients with breast cancer is extremely complex and requires interdisciplinary care in certified facilities. These specialized facilities provide numerous services without being correspondingly remunerated. The question whether breast cancer surgery should be performed in an outpatient setting to reduce costs is increasingly being debated. This study compares inpatient surgical treatment with a model of the same surgery performed on an outpatient basis to examine the potential financial impact. Material and Methods A theoretical model was developed and the DRG fees for surgical interventions to treat primary breast cancer were calculated. A theoretical 1-day DRG was then calculated to permit comparisons with outpatient procedures. The costs of outpatient surgery were calculated based on the remuneration rates of the AOP (Outpatient Surgery) Contract and the EBM (Uniform Assessment Scale) and compared to the costs of the 1-day DRG. Results The DRG fee for both breast-conserving surgery and mastectomy is higher than the fee paid in the context of the EBM system, although the same procedures were carried out in both systems. If a hospital were to carry out breast-conserving surgery as an outpatient procedure, the fee would be € 1313.81; depending on the type of surgery, the hospital would therefore only receive between 39.20% and 52.82% of the DRG fee. This was the case even for a 1-day treatment. Compared to the real DRG fees the difference would be even more striking. Conclusion Carrying out breast cancer surgery as an outpatient procedure would result in a significant shortfall of revenues. Additional services from certified centers, such as the interdisciplinary planning of treatment, psycho-oncological and social-medical care with the involvement of relatives, detailed documentation, etc., which are currently provided without surcharge or adequate remuneration, could no longer be maintained. The quality of processes and excellent results which have been achieved and ultimately the care given by certified facilities would be significantly at risk.

Introduction Studies of triple-negative breast cancer have recently been extending the inclusion criteria and incorporating additional molecular markers into the selection criteria, opening up scope for targeted therapies. The screening phases required for studies of this type are often prolonged, since the process of determining the molecular subtype and carrying out additional biomarker assessment is time-consuming. Parameters such as germline genotypes capable of predicting the molecular subtype before it becomes available from pathology might be helpful for treatment planning and optimizing the timing and cost of screening phases. This appears to be feasible, as rapid and low-cost genotyping methods are becoming increasingly available. The aim of this study was to identify single nucleotide polymorphisms (SNPs) for breast cancer risk capable of predicting triple negativity, in addition to clinical predictors, in breast cancer patients. Methods This cross-sectional observational study included 1271 women with invasive breast cancer who were treated at a university hospital. A total of 76 validated breast cancer risk SNPs were successfully genotyped. Univariate associations between each SNP and triple negativity were explored using logistic regression analyses. Several variable selection and regression techniques were applied to identify a set of SNPs that together improve the prediction of triple negativity in addition to the clinical predictors of age at diagnosis and body mass index (BMI). The most accurate prediction method was determined by cross-validation. Results The SNP rs10069690 (TERT, CLPTM1L) was the only significant SNP (corrected p = 0.02) after correction of p values for multiple testing in the univariate analyses. This SNP and three additional SNPs from the genes RAD51B, CCND1, and FGFR2 were selected for prediction of triple negativity. The addition of these SNPs to clinical predictors increased the cross-validated area under the curve (AUC) from 0.618 to 0.625. Age at diagnosis was the strongest predictor, stronger than any genetic characteristics. Conclusion Prediction of triple-negative breast cancer can be improved if SNPs associated with breast cancer risk are added to a prediction rule based on age at diagnosis and BMI. This finding could be used for prescreening purposes in complex molecular therapy studies for triple-negative breast cancer. Einleitung Studien bei triple-negativem Brustkrebs haben die Einschlusskriterien durch die Aufnahme zusatzlicher molekularer Marker erweitert. Im Rahmen des Screenings fur diese Therapiestudien wird sowohl fur die Bestimmung des molekularen Subtyps als als auch fur zusatzliche Biomarker-Untersuchungen ein langerer Zeitraum beansprucht, was die Behandlung verzogert. Keimbahn-Genotypen konnten bei der Vorhersage des molekularen Subtyps helfen, zumal schnelle und gunstige Genotypisierungsmethoden zunehmend zur Verfugung stehen. Ziel dieser Studie war es deswegen, zu prufen, ob Einzelnukleotid-Polymorphismen (SNPs) der Keimbahn dabei helfen konnen, Brustkrebspatientinnen mit triple-negativem Mammakarzinom zu identifizieren. Methoden In dieser Querschnittsstudie wurden 1271 Patientinnen mit invasivem Mammakarzinom eingeschlossen. Insgesamt wurden 76 validierte Brustkrebsrisiko-SNPs erfolgreich genotypisiert. Univariate Assoziationen zwischen jedem SNP und Triple-Negativitat wurden mittels logistischer Regression gepruft. Verschiedene Variablenselektions- und Regressionsmethoden wurden angewandt, um eine Gruppe von SNPs zu identifizieren, die zusammen mit den klinischen Pradiktoren Alter bei Diagnose und BMI die Pradiktion der Triple-Negativitat verbessern. Mittels Kreuzvalidierung wurde die Methode mit der hochsten Genauigkeit bestimmt. Ergebnisse Der SNP rs10069690 (TERT, CLPTM1L) war der einzige einzelne SNP, der nach p-Wert-Korrektur fur multiples Testen signifikant mit Triple-Negativitat assoziiert war (p = 0,02). Dieser SNP und 3 weitere in den Genen RAD51B, CCND1 und FGFR2 wurden ausgewahlt, um gemeinsam in einem Pradiktionsmodell Triple-Negativitat vorherzusagen. Die Hinzunahme dieser 4 SNPs erhohte die kreuzvalidierte AUC von 0,618 auf 0,625. Alter bei Diagnose war bei Weitem der starkste Pradiktor. Schlussfolgerung Die Vorhersage von triple-negativem Mammakarzinom kann verbessert werden, wenn sie nicht nur auf den klinischen Pradiktoren Alter bei Diagnose und BMI basiert, sondern auch auf Brustkrebsrisiko-SNPs. Das Pradiktionsmodell konnte bei der Rekrutierung von Patientinnen fur aufwendige molekulare Therapiestudien eingesetzt werden.

Zusammenfassung Ziel Die Kombination verschiedener bildgebender Verfahren in Fusionsmaschinen verspricht, eine deutliche Verbesserung der Brustdiagnostik mit sich zu bringen. Hier wollen wir die Bildqualität und die klinische Anwendbarkeit eines Fusionsprototypen aus einem Standard-Mammografie/Tomosynthese-Gerät und einem Standard-3-D-Ultraschallkopf unter Zuhilfenahme einer neuen Methode der Brustkomprimierung evaluieren. Material und Methoden Für die Untersuchung an 5 Mastektomiepräparaten von Patientinnen mit histologisch gesichertem DCIS oder invasivem Mammakarzinom (BI-RADS™ 6) wurde an einem präklinischen Fusionsprototyp ein Ultraschallkopf eines ABVS-Systems aus einem Acuson S2000 in einen MAMMOMAT Inspiration (beide Siemens Healthcare GmbH) unter Zuhilfenahme einer neu entwickelten Kompressionsplatte integriert und digitale Mammografien und 3-D-Bilder per automatisiertem Ultraschall aufgenommen. Ergebnisse Die durch den Fusionsprototyp aufgenommenen digitalen Mammografien sind von vergleichbarer Qualität wie unter herkömmlicher Kompression entstandene Aufnahmen. Die neu entwickelte Kompressionsplatte hat keinen Einfluss auf die applizierte Röntgendosis. Der personelle und zeitliche Aufwand für die Mammografie unterscheidet sich nicht zur herkömmlichen Mammografie. Die Fusion aus Mammografie und Ultraschall lässt sich technisch umsetzen. Schlussfolgerung Die Fusion eines automatisierten 3-D-Ultraschallgeräts mit einem Standard-Mammografiegerät liefert an unseren wenigen Mastektomiepräparaten Mammografieaufnahmen von vergleichbarer Qualität. Darüber hinaus ermöglicht das Gerät den simultanen Ultraschall als 2. Bildmodalität der komplementären Mammadiagnostik ohne einen signifikanten Zeit- und zusätzlichen Untersucheraufwand.

Introduction The placement of intramammary marker clips has proven to be helpful for tumor localization in patients undergoing neoadjuvant chemotherapy and breast-conserving surgery. The purpose of our study was to investigate the feasibility of using a clip marker system for breast cancer localization and its influence on the imaging assessment of treatment responses after neoadjuvant chemotherapy. Patients and Methods Between March and June 2015, a total of 25 patients (n = 25), with a suspicion of invasive breast cancer with diameters of at least 2 cm (cT2), underwent preoperative sonographically guided core needle biopsy using a single-use breast biopsy system (HistoCore™) and intramammary clip marking using a directly adapted clip system based on the established O-Twist Marker™, before their scheduled preoperative neoadjuvant chemotherapy. Localization of the intramammary marker clip was controlled by sonography and digital breast tomosynthesis. Results Sonography detected no dislocation of intrammammary marker clips in 20 of 25 patients (80 %), while digital breast tomosynthesis showed accurate placement without dislocation in 24 patients (96 %) (p Conclusion Our study underscores the importance of intramammary marking clip systems before neoadjuvant chemotherapy. Placement of marker clips is advised to facilitate accurate tumor bed localization. With regard to digital breast tomosynthesis, its development continues to improve the quality of diagnostics and the therapy of breast cancer particularly for small breast cancer tumors or in neoadjuvant chemotherapy setting.

Rationale and Objectives This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers. Materials and Methods A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves. Results Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT. Conclusions pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.

Objective Three-dimensional (3D) printing has become widely available, and a few cases of its use in clinical practice have been described. The aim of this study was to explore facilities for the semi-automated delineation of breast cancer tumors and to assess the feasibility of 3D printing of breast cancer tumors. Methods In a case series of five patients, different 3D imaging methods—magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and 3D ultrasound—were used to capture 3D data for breast cancer tumors. The volumes of the breast tumors were calculated to assess the comparability of the breast tumor models, and the MRI information was used to render models on a commercially available 3D printer to materialize the tumors. Results The tumor volumes calculated from the different 3D methods appeared to be comparable. Tumor models with volumes between 325 mm3 and 7,770 mm3 were printed and compared with the models rendered from MRI. The materialization of the tumors reflected the computer models of them. Conclusion 3D printing (rapid prototyping) appears to be feasible. Scenarios for the clinical use of the technology might include presenting the model to the surgeon to provide a better understanding of the tumor's spatial characteristics in the breast, in order to improve decision-making in relation to neoadjuvant chemotherapy or surgical approaches. J. Surg. Oncol. 2017;115:238–242. © 2016 Wiley Periodicals, Inc.

Although mammography screening programs do not include ultrasound examinations, some diagnostic units do provide women with both mammography and ultrasonography. This article is concerned with estimating the risk of a breast cancer patient diagnosed in a hospital-based mammography unit having a tumor that is visible on ultrasound but not on mammography. A total of 1,399 women with invasive breast cancer from a hospital-based diagnostic mammography unit were included in this retrospective study. For inclusion, mammograms from the time of the primary diagnosis had to be available for computer-assisted assessment of percentage mammographic density (PMD), as well as Breast Imaging Reporting and Data System (BIRADS) assessment of mammography. In addition, ultrasound findings were available for the complete cohort as part of routine diagnostic procedures, regardless of any patient or imaging characteristics. Logistic regression analyses were conducted to identify predictors of mammography failure, defined as BIRADS assessment 1 or 2. The probability that the visibility of a tumor might be masked at diagnosis was estimated using a regression model with the identified predictors. Tumors were only visible on ultrasound in 107 cases (7.6%). PMD was the strongest predictor for mammography failure, but age, body mass index and previous breast surgery also influenced the risk, independently of the PMD. Risk probabilities ranged from 1% for a defined low-risk group up to 40% for a high-risk group. These findings might help identify women who should be offered ultrasound examinations in addition to mammography.

Neoadjuvant combination treatment with chemotherapy (CTX), trastuzumab (TZM), and pertuzumab (PTZ) has been shown to result in higher pathological complete response rates (pCR) in comparison with treatment with chemotherapy and trastuzumab (CTX/TZM). This analysis was aimed at real-world validation of these results from prospective randomized trials. In a retrospective analysis conducted in the PRAEGNANT network, patients were eligible for inclusion if they had either received neoadjuvant therapy with CTX/TZM or chemotherapy, trastuzumab, and pertuzumab (CTX/TZM/PTZ) and subsequently underwent surgery for their primary breast cancer. The effect of the two neoadjuvant regimens on pCR in addition to commonly applicable predictors of pCR was analyzed in 300 patients from three study sites, using logistic regression analyses with treatment arm, age, clinical tumor stage, grading, and hormone receptor status as predictors. pCR with complete disappearance of all tumor cells was seen in 30.2% (n = 58) of patients treated with CTX/TZM and in 52.8% (n = 57) of those treated with CTX/TZM/PTZ. CTX/TZM/PTZ was positively associated with pCR (adjusted odds ratio 2.44; 95% CI 1.49–4.02). Mastectomy rates were not influenced by the therapy. The results of clinical trials were confirmed in this dataset of patients who were treated outside of clinical trials in everyday routine work. pCR rates can be improved by 20% with pertuzumab in routine clinical use.

Objective We performed a prospective monocentric study to inter-individually compare the diagnostic accuracy of breast MRI at 1.5 T and 3 T. Methods During a consecutive period of 12 months all 982 patients receiving breast MRI according to standard indications (problem solving, preoperative staging) were randomized to one 3 T or 1.5 T scanner both equipped with dedicated 16-channel breast coils. Protocols at 1.5 T and 3 T were optimized and in line with international recommendations. Due to restricted time slot availabilities, the randomization-key was defined as 1/10 (3 T/1.5 T). All examinations were read by two experts in breast MRI (>25 and 8 years of experience) who assigned a BI-RADS category per breast. Histopathological verification or long-term MRI follow-up (>24 months) served as standard of reference. Results were analyzed using cross tabulations, standard estimates of diagnostic accuracy, Chi-square test and Mann-Whitney U test (alpha = 5%). Results 1961 breasts were included. 1746 (89%) were imaged at 1.5 T and 215 at 3 T (11%). The 1.5 T and 3 T study cohort did not show significant differences regarding patient age (P = 0.71), results of the reference standard (P = 0.09) and indication for MRI (P = 0.53). Overall Sensitivity (94.7%), Specificity (91.4%), Accuracy (91.9%) and Negative Predictive Value (99.0%) were within the range of the literature. Pairwise comparison of Sensitivity (1,5 T/3 T: 94.1/97.9%), Specificity (91.6/%89.3%), Accuracy (92.0%/91.2%) and Negative Predictive Value (98.9%/99.3%) were without significant differences (P = 0.29-0.74). Conclusion In this prospective monocentric study, we identified comparably high diagnostic accuracy for both 1.5 T and 3 T breast MRI. Both 1.5 T and 3 T are equally suited for breast imaging.

Over the last two decades genetic testing for mutations in BRCA1 and BRCA2 has become standard of care for women and men who are at familial risk for breast or ovarian cancer. Currently, genetic testing more often also includes so-called panel genes, which are assumed to be moderate-risk genes for breast cancer. Recently, new large-scale studies provided more information about the risk estimation of those genes. The utilization of information on panel genes with regard to their association with the individual breast cancer risk might become part of future clinical practice. Furthermore, large efforts have been made to understand the influence of common genetic variants with a low impact on breast cancer risk. For this purpose, almost 450 000 individuals have been genotyped for almost 500 000 genetic variants in the OncoArray project. Based on first results it can be assumed that – together with previously identified common variants – more than 170 breast cancer risk single nucleotide polymorphisms can explain up to 18% of familial breast cancer risk. The knowledge about genetic and non-genetic risk factors and its implementation in clinical practice could especially be of use for individualized prevention. This includes an individualized risk prediction as well as the individualized selection of screening methods regarding imaging and possible lifestyle interventions. The aim of this review is to summarize the most recent developments in this area and to provide an overview on breast cancer risk genes, risk prediction models and their utilization for the individual patient.

Introduction For decades, conventional galactography was the only imaging technique capable of showing the mammary ducts. Today, diagnosis is based on a multimodal concept which combines high-resolution ultrasound with magnetic resonance (MR) mammography and ductoscopy/galactoscopy and has a sensitivity and specificity of up to 95%. This study used tomosynthesis in galactography for the first time and compared the synthetic digital 2D full-field mammograms generated with this technique with the images created using the established method of ductal sonography. Both methods should be able to detect invasive breast cancers and their precursors such as ductal carcinoma in situ (DCIS) as well as being able to identify benign findings. Material and Methods Five patients with pathological nipple discharge were examined using ductal sonography, contrast-enhanced 3D galactography with tomosynthesis and the synthetic digital 2D full-field mammograms generated with the latter method. Evaluation of the images created with the different imaging modalities was done by three investigators with varying levels of experience with complementary breast diagnostics (1, 5 and 15 years), and their evaluations were compared with the histological findings. Results All 3 investigators independently evaluated the images created with ductal sonography, contrast-enhanced 3D galactography with tomosynthesis, and generated synthetic digital 2D full-field mammograms. Their evaluations were compared with the histopathological assessment of the surgical specimens resected from the 5 patients. There was 1 case of invasive breast cancer, 2 cases with ductal carcinoma in situ and 2 cases with benign findings. All 3 investigators made more mistakes when they used the standard imaging technique of ductal sonography to diagnose suspicious lesions than when they used contrast-enhanced galactography with tomosynthesis and the generated synthetic digital 2D full-field mammograms. Conclusion This is the first time breast tomosynthesis was used in galactography (galactomosynthesis) to create digital 3-dimensional images of suspicious findings. When used together with the generated synthetic digital 2D full-field mammograms, it could be a useful complementary procedure for the diagnosis of breast anomalies and could herald a renaissance of this method. Compared with high-resolution ductal ultrasound, the investigators achieved better results with contrast-enhanced galactography using tomosynthesis and the generated synthetic digital 2D full-field mammograms, as confirmed by histopathological findings.