Enhancement parameters on dynamic contrast enhanced breast MRI: do they correlate with prognostic factors and subtypes of breast cancers?

OBJECTIVE: To correlate the enhancement parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with prognostic factors and immunohistochemical subtypes of breast cancer. MATERIAL AND METHODS: A total of 81 breast carcinomas were included in our study. We obtained the following enhancement parameters: 1) analysis of background parenchymal enhancement (BPE) and BPE coefficients (BEC) from bilateral breasts, 2) the number of vessels per breast as a representation of ipsilateral whole-breast vascularity. Additionally, in 50 patients, 3) semiquantitative parameters of tumors (the initial enhancement percentage (E1), the peak enhancement percentage (Epeak), the time to peak enhancement (TTP), the signal enhancement ratio (SER)) and 4) perfusion parameters (K(trans), kep, ve and iAUC) from tumors and ipsilateral breasts were also obtained. Correlations among parameters and prognostic factors, including tumor size, axillary node status, nuclear grade, histologic grade, estrogen receptor (ER) expression, progesterone receptor (PR) expression, Ki-67, human epidermal growth factor receptor 2 (HER-2) expression, epidermal growth factor receptor (EGFR) expression, bcl-2, CK5/6 and subtypes categorized as luminal (ER or PR positive), triple negative (ER or PR negative, HER-2 negative) and HER2 (ER and PR negative with HER-2 overexpression) were analyzed. RESULTS: BPE was significantly correlated with EGFR expression (p=0.040). BEC was significantly higher in tumors larger than 2cm than in tumors smaller than 2cm (p=0.001). The vessel numbers in ipsilateral breasts were higher in tumors larger than 2cm than in tumors smaller than 2cm (p=0.034), with higher nuclear grades (grade 3) than with lower nuclear grades (grade 1,2) (p=0.001) and with PR-negative rather than with PR-positive (p=0.010) results. The mean K(trans) was higher in Ki-67-positive tumors than Ki-67 negative tumors (p=0.002). The mean kep was higher in Ki-67-positive tumors than in Ki-67-negative tumors (p=0.005) and in CK5/6-positive tumors than in CK5/6-negative tumors (p=0.015). The mean K(trans) was lower in the ipsilateral breast parenchyma with HER-2-positive tumors compared to HER-2-negative tumors (p=0.012). CONCLUSION: BPE, BEC and ipsilateral whole-breast vascularity, higher K(trans) and kep of the cancer and lower K(trans) and iAUC of ipsilateral breast parenchyma may serve as additional predictors of a poor breast cancer prognosis.

Ultrasonographic features of spontaneous breast tumor infarction.

BACKGROUND: The aim of this paper is to evaluate the ultrasonographic features of spontaneous breast tumor infarction. METHODS: The pathologic information system database of the Department of Radiology was retrospectively searched. Between 2009 and 2011, nine cases in eight patients were pathologically confirmed as spontaneous breast tumor infarctions. Mammographic images and the ultrasonographic images were acquired. Two other radiologists analyzed the mammographic and ultrasonographic findings. RESULTS: Most common features were oval, indistinct, heterogeneously hypoechoic mass with posterior enhancement. All lesions were classified as C4 (suspicious finding) except one case. CONCLUSION: Spontaneous breast tumor infarction should be included in the differential diagnoses of hetereogeneously hypoechoic suspicious solid lesions mimicking malignancy.

MRI volume measurements compared with the RECIST 1.1 for evaluating the response to neoadjuvant chemotherapy for mass-type lesions.

BACKGROUND: The purpose of this study was to compare the accuracy of volumetric (3D) measurements with that of unidimensional (1D) measurements by response evaluation criteria in solid tumors 1.1 (RECIST 1.1) in patients with breast cancer before and after neoadjuvant chemotherapy. METHODS: The study included 48 patients with breast cancer who underwent neoadjuvant chemotherapy. Dynamic contrast-enhanced magnetic resonance imaging was performed before the first cycle of chemotherapy and after the completion of the planned chemotherapy. The longest diameter and volume of each target lesion were measured using a TeraRecon Aquarius workstation (San Mateo, CA). Response was assessed both by using the RECIST 1.1 and volumetric criteria. Histologic response was assessed using the Sataloff criteria. The agreements between the two measures and the histologic response were analyzed statistically. RESULTS: In monitoring the response to neoadjuvant chemotherapy, the 1D and 3D measurements showed "good agreement" (κ = 0.610) for the treatment response categories and "moderate agreement" (κ = 0.565) for the responder/non-responder categories. Disagreement was observed in 9 out of 48 comparisons (18.75 %). The percent agreement of the 1D measurement of residual lesions (79.17 %) with the pathology was higher than that by volumetric measurement (70.83 %), but there was no statistically significant difference (p = 0.35). Both the 1D (rho = 0.67, p < 0.0001) and 3D measurements (rho = 0.52, p < 0.0001) showed a moderate degree of linear correlation with the pathologic diameter of residual lesions. CONCLUSION: There was generally good agreement between the 1D and 3D measurements and moderate predictive value using either approach for predicting pathological response.

Imaging features of invasive lobular carcinoma: comparison with invasive ductal carcinoma.

PURPOSE: The aim of this study was to evaluate the imaging findings of invasive lobular carcinoma (ILC) compared to those of invasive ductal carcinoma (IDC). MATERIALS AND METHODS: The study included ILCs (n = 27) and IDCs (n = 85). Imaging findings were retrospectively evaluated, according to the BI-RADS lexicon. We compared the imaging findings, multiplicity, and magnetic resonance imaging (MRI) detection accuracy of ILC with those of IDC. RESULTS: At mammography, normal findings and mass lesions were more frequent with ILCs (14.8% and 59.2%, respectively) than with IDCs (1.2% and 44.7%, respectively) (P = 0.009). With ultrasonography (US), posterior acoustic shadowing was more frequently seen in ILCs (59.2%) than in IDCs (15.8%) (P < 0.001). With MRI, both ILCs and IDCs most commonly appeared as a heterogeneously enhancing, irregular mass with a spiculated border. Multifocality was more frequently associated with ILCs (40.7%) than with IDCs (14.1% 1% 0.002). However, multicentricity and bilaterality were not different between the two groups. The sensitivity and specificity of MRI for the detection of multiplicity were 91.6% and 73.3%, respectively, for ILCs and 83.3% and 80.3%, respectively, for IDCs. CONCLUSION: Normal findings, mass lesions on mammography, and posterior acoustic shadowing on US were more frequently associated with ILCs than with IDCs. Multifocality was more prevalent with ILCs than with IDCs.

Clinical characteristics of metastatic tumors to the ovaries.

Approximately 5-30% of the ovarian cancers are metastatic malignancies. The prevalence of metastatic ovarian tumors varies with the incidence rates and spread patterns of primary malignancies. We evaluated the prevalence, pre- and postoperative characteristics of metastatic ovarian cancer in Korean women. We reviewed the records for 821 ovarian malignancies with pathological consultation from 1996-2006 and recorded patient demographical, radiological, histopathological, and survival data. The study included 112 cases of histologically confirmed metastatic ovarian cancer. Metastatic ovarian cancer accounted for 13.6% of all ovarian malignancy, primarily arising from the gastrointestinal tract. The preoperative detection rate with imaging was 75%, and none of the radiological or serological features were useful for differential diagnosis. In multivariate analysis for prognostic variables, the only significant factor was the primary tumor site (p=0.004). Furthermore, extensive resection increased survival for some patients. The differential diagnosis of metastatic ovarian cancer can be problematic, so multiple diagnostic approaches are necessary. The extent of cytoreductive surgery for this type of tumor must be decided on a case-by-case basis.

[Immunohistochemical expression of the p53 and Ki-67 proteins in Barrett's esophagus in Korea].

BACKGROUND/AIMS: Barrett's esophagus is a premalignant lesion of the esophagus in which normal squamous epithelium is replaced by intestinalized columnar epithelium. In Korea, adenocarcinoma associated with Barrett's esophagus is rare compared with that of Western country. The purpose of this study was to investigate the immunohistochemical expression of p53 and Ki-67 in Barrett's esophagus which had predictive value for cancer risk in Korea. METHODS: Ninety five patients (43 male and 52 female, median age 44, range 21-75) who have been suspected to have Barrett's esophagus by endoscopic assessment were enrolled in this study. Alcian blue (pH 2.5) and high ion diamine stain for the evaluation of specialized intestinal metaplasia (SIM) and immunohistochemical stain for p53 and Ki-67 were done. RESULTS: 57.9% (55/95) of biopsies from the columnar lined esophagus showed SIM, but no dysplasia. 56.4% (31/55) of Barrett's esophagus showed sulfomucin positive colonic metaplasia. The p53 expression was observed in 10.9% (6/55) of the patients of Barrett's esophagus and all of them showed colonic metaplasia. Ki-67 labeling index showed no difference significantly. CONCLUSIONS: In Korea, 10.9% of Barrett's esophagus had p53 mutation and moreover all of them had colonic metaplasia. Consequently, we expect that these patients have high risk of developing dysplasia and adenocarcinoma and need careful follow-up.