Response Evaluation to Neoadjuvant Chemotherapy in Breast Cancer Patients: Sequential Dynamic Contrast-Enhanced MRI Using Computer-Aided Detection

Purpose@#We evaluated whether there is an association between sequential changes in kinetic profiles by computer-aided detection (CAD) during neoadjuvant chemotherapy (NAC) and pathologic complete response (pCR) and residual cancer burden (RCB) in dynamic contrast-enhanced MRI (DCE-MRI) of patients with invasive breast cancer. @*Materials and Methods@#This retrospective study involved 51 patients (median age, 48 years; range, 33–60 years) who underwent pre-, interim-, and post-NAC DCE-MRIs at 3 T. The tumor size and CAD-generated kinetic profiles (peak enhancement and delayed enhancement [persistent, plateau, and washout] components) were measured. Percentage changes in pre- and interim-NAC (ΔMRI value1) and pre- and post-NAC (ΔMRI value2) were compared between pCR and non-pCR cases, and according to RCB. Receiver operating characteristic curve analysis was performed to evaluate the association between pCR and MRI parameters (including CAD-generated kinetic profiles). @*Results@#The pCR rate was 19.6% (10/51). There were statistically significant differences in Δtumor size2 (p < 0.01), Δpeak enhancement2 (p = 0.01), Δpersistent2 (p = 0.01), Δplateau2 (p = 0.02), and Δwashout2 (p = 0.03) between pCR and non-pCR. ΔTumor size2 provided very good diagnostic accuracy for pCR (cut-off, -90%; area under the curve, 0.88). There were differences in Δtumor size2, Δpeak enhancement2, Δplateau2, and Δwashout2 between RCB classes (p < 0.01). @*Conclusion@#DCE-MRI using CAD has the potential for predicting pCR and RCB classes.

Preoperative High Neutrophil-Lymphocyte Ratio May Be Associated with Lateral Lymph Node Metastasis in Patients with Papillary Thyroid Cancers

BACKGROUND AND OBJECTIVES: The present study investigated the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and poor prognostic outcomes in conventional papillary thyroid carcinomas (cPTCs). MATERIALS AND METHODS: Two hundred and five patients who underwent total thyroidectomy for cPTCs larger than 10 mm were evaluated retrospectively. Patients were classified into the low NLR (n=103) and high NLR (n=102) groups by the median NLR value (1.78) and logistic regression analysis was used to evaluate whether the NLR predicted aggressive PTC features. Patients were also classified into the disease-free (n=183) and persistence/recurrence (n=22) groups and Cox regression analysis was used to investigate factors affecting persistence/recurrence by Cox regression analysis. RESULTS: The high NLR group had a higher presence of lateral lymph node metastasis (p=0.004) and higher radioactive iodine doses (p=0.006) than the low NLR group. High NLR was an independent predictor of lateral lymph node metastasis (LNM) (OR, 2.786; p=0.005) but was not significantly associated with persistence/recurrence. CONCLUSION: Preoperative high NLR was an independent predictor of lateral LNM in cPTCs.

Invasive Lobular Carcinoma: Detection and Multiplicity with Multimodalities / 이화의대지

OBJECTIVES: We aimed to compare the diagnostic performances of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), magnetic resonance imaging (MRI), breast specific gamma imaging (BSGI) and/or positron emission tomography/computed tomography (PET/CT) for the detection of invasive lobular carcinoma (ILC). METHODS: Index ILCs and multifocal/multicentric (multiple) ILCs were analyzed using various imaging modalities. The final surgical pathology was regarded as the reference standard. The detection rate for index cancers and the diagnostic performance for multiple ILCs per breast were evaluated. RESULTS: Seventy-eight ILCs in 76 women were enrolled. Twenty-six breasts had multiple ILCs. DM (n=72), DBT (n=15), US (n=77), MRI (n=76), BSGI (n=50), and /or PET/CT (n=74) were performed. For index cancer, the detection rate was 100% for DBT, US, and MRI. For multiple ILCs, the sensitivity was 100% for DBT and MRI (P<0.001). The diagnostic accuracy for multiple ILCs were 73.3% for DBT and 73.0% for PET/CT (P=0.460). CONCLUSION: DBT was the most accurate imaging modality for both index and multiple ILCs. PET/CT was also valuable for multiple ILCs, whereas DM and BSGI showed relatively low diagnostic performances. DBT and PET/CT have promising roles in the diagnosis of multiple ILCs.