MR imaging properties of breast cancer molecular subtypes.

OBJECTIVE: In this study, we aim at investigating the magnetic resonance (MR) imaging features of molecular subtypes, according to the BIRADS Atlas. PATIENTS AND METHODS: The preoperative MRI examinations of 104 breast cancer patients were reviewed retrospectively using the 5th Edition Breast Imaging-Reporting and Data System (BI-RADS) Atlas. According to BI-RADS, cases were classified as mass or non-mass enhancement. Background parenchymal enhancements of the cases were evaluated. The population was examined for shape, contour, enhancement characteristics of masses, distribution and internal enhancement patterns of non-mass enhancements, background parenchymal enhancement, multifocal/multicentric (MFMS) status, presence of axillary LAP, ADC values, and kinetic aspects. The Kruskal-Wallis and Chi-square tests were used to explore the connection between molecular subtypes and MR data. RESULTS: The link between molecular subtypes and mass/non-mass enhancement was discovered to be statistically significant (p=0.007). The shape (p=0.001) and contour (p=0.001) properties of the masses were observed to differ depending on the molecular subtypes. The Luminal types were usually irregularly shaped with irregular/spiculated contours, whereas the HER-2 (+) and Triple (-) subtypes were mostly oval/round with smooth contours. The subtype with the highest non-mass enhancement rate (70%) was HER-2 (+). Axillary lymphadenopathy was most common (64.3%) in the Triple (-) subtype (p=0.033). CONCLUSIONS: According to the BIRADS Atlas, molecular subtypes exhibit a wide range of imaging properties in MR in our study.

Should we report Breslow density, a new concept in cutaneous melanoma?

INTRODUCTION: Breslow density is a newly defined biomarker, independent of Breslow thickness. We aimed to investigate the relationship of Breslow density with other clinicopathological prognostic factors and its effect on the overall survival and disease-free survival in patients with cutaneous melanomas. MATERIALS & METHODS: This was a single-centre retrospective study of patients (n = 19) diagnosed with cutaneous malignant melanomas in our hospital between 2011 and 2019 were included in the study. The exclusion criteria were in situ melanomas, punch or incisional biopsies and metastasis at the time of the diagnosis. Breslow density was determined by reevaluating slides obtained at the time of the initial diagnoses. The effect of Breslow density on survival was determined using univariate and multivariate Cox proportional risk analyses. RESULTS: In terms of the overall survival, mortality risk increased as Breslow density increased (p = 0.044). Breslow density was not significantly associated with the overall survival in the multivariate model (p = 0.078). In terms of disease-free survival, the risk of metastasis or recurrence increased 1.229- fold in accordance with an increase in Breslow thickness (CI: 1.057-1.428), whereas increased Breslow density increased the metastasis or recurrence risk 1.059-fold (CI: 1.008-1.112). In the multivariate model, only Breslow density was statistically significant (p = 0.046). CONCLUSIONS: As a semi-quantitative and subjective measurement, Breslow density is not a completely accurate representation of the invasive tumour load. However, the measurement is practical and low cost and requires no additional equipment. Therefore, Breslow density can be measured in every laboratory. Considering the value of Breslow density in predicting the prognosis in patients with cutaneous melanomas and strong inter-observer compliance observed in the present study, we believe that it would be useful to include this measurement in pathology reports.

Anaesthesia and the QT interval in humans. The effects of isoflurane and halothane.

Prolongation of the QT interval may cause potentially hazardous arrhythmias. The effects on the QT interval (QTc, corrected for heart rate) of isoflurane and halothane followed by vecuronium have been investigated during induction of anaesthesia in 51 patients. All patients were ASA 1 or 2, without cardiovascular problems or electrolyte abnormalities and were not receiving medication. Midazolam 0.08 mg.kg-1 was administered intramuscularly for premedication. Anaesthesia was induced with either isoflurane (n = 26) or halothane (n = 25), and the inspired concentration increased to reach an end-tidal concentration of 2.5% to 3%. Recordings of ECG, heart rate, systolic and diastolic arterial pressure were obtained at the following times: prior to induction of anaesthesia; 1 min and 3 min after a stable end-tidal concentration had been reached; 1 min and 3 min following vecuronium administration, at the time of tracheal intubation and 1 min and 3 min later. Halothane significantly shortened QTc (p < 0.05 to p < 0.001), in contrast to isoflurane which prolonged it (p < 0.01). The heart rate decreased (p < 0.01 to p < 0.001) after induction of anaesthesia with halothane and returned to pre-induction values after tracheal intubation. In contrast, heart rate increased after induction with isoflurane and increased further after laryngoscopy and tracheal intubation (p < 0.001). In the isoflurane group, ST depression was noticed in seven patients and nodal rhythm in two, while in the halothane group seven patients developed nodal rhythm and, in two patients, ventricular ectopics were recorded. There were no sequelae. In both groups, systolic and diastolic arterial pressure decreased after induction of anaesthesia (p < 0.01 to p < 0.001), increasing again after intubation.