Triple-negative breast cancer: Pretreatment magnetic resonance imaging features and clinicopathological factors associated with recurrence.

PURPOSE: We aimed to investigate the magnetic resonance imaging (MRI) features and clinicopathologic factors with recurrence of triple-negative breast cancer (TNBC). PATIENTS AND METHODS: We identified 281 patients with 288 surgically confirmed TNBC lesions who underwent pretreatment MRI between 2009 and 2015. The presence of intratumoral high signal on T2-weighted images, high-signal rim on diffusion-weighted images (DWI), and rim enhancement on the dynamic contrast-enhanced MRI and clinicopathological data were collected. Cox proportional analysis was performed. RESULTS: Of the 288 lesions, 36 (12.5%) recurred after a median follow-up of 18 months (range, 3.6-68.3 months). Rim enhancement (hazard ratio [HR] = 3.15; 95% confidence interval [CI] = 1.01, 9.88; p = .048), and lymphovascular invasion (HR = 2.73, 95% CI = 1.20, 6.23; p = .016) were independently associated with disease recurrence. While fibroglandular volume, background parenchymal enhancement, intratumoral T2 high signal, and high-signal rim on DWI, were not found to be risk factors for recurrence. CONCLUSION: Pretreatment MRI features may help predict a high risk of recurrence in patients with TNBC.

Rim sign and histogram analysis of apparent diffusion coefficient values on diffusion-weighted MRI in triple-negative breast cancer: Comparison with ER-positive subtype.

PURPOSE: To investigate associations between the clinicopathologic features and MRI features of triple-negative breast cancer (TNBC) and ER-positive breast cancer (BC) via apparent diffusion coefficient (ADC) histogram analysis. MATERIALS AND METHODS: In this study, 221 breast cancer patients with pre-operative MRI performed from August 2009 to March 2015 were included in a retrospective analysis. All patients had a pathologically confirmed diagnosis of invasive carcinoma and were grouped into ER-positive (149) or triple-negative (72) subtypes. DWI rim sign and various ADC parameters (mean; mode; 25, 50, and 75 percentiles; skewness; and kurtosis) between ER-positive and TNBC were compared using whole-lesion ADC histogram analysis. Univariate and multivariate regression analyses were used for statistical comparison. RESULTS: DWI rim signs were detected in 42.3% and 41.7% of ER-positive subtype and TNBC, respectively (P = 0.931). TNBC had poorer histologic grade (P<0.001) and higher Ki-67 expression (P <0.001) than ER-positive subtype BC. TNBC displayed higher ADC parameters (mean, mode, 50th & 75th percentiles, kurtosis on univariate analysis, all P<0.001; only kurtosis on multivariate anaylsis; P<0.001) than ER-positive subtype BC. TNBC had significantly more recurrence events than ER-positive subtype BC on univarate analysis (9.7% (7/72) vs. 2.7% (4/149), P = 0.035). CONCLUSION: Poorer clinicopathologic outcomes were found in TNBC. Whole-lesion ADC histogram analysis revealed ADC kurtosis to be higher in TNBC than ER-positive subtype BC.

Diagnostic Performance of and Breast Tissue Changes at Early Breast MR Imaging Surveillance in Women after Breast Conservation Therapy.

Purpose To investigate the diagnostic performance and tissue changes in early (1 year or less) breast magnetic resonance (MR) imaging surveillance in women who underwent breast conservation therapy for breast cancer. Materials and Methods This prospective study was approved by the institutional review board, and written informed consent was obtained. Between April 2014 and June 2016, 414 women (mean age, 51.5 years; range, 21-81 years) who underwent 422 early surveillance breast MR imaging examinations (median, 6.0 months; range, 2-12 months) after breast conservation therapy were studied. The cancer detection rate, positive predictive value of biopsy, sensitivity, specificity, accuracy, and area under the curve of surveillance MR imaging, mammography, and ultrasonography (US) were assessed. Follow-up was also obtained in 95 women by using positron emission tomography (PET)/computed tomography (CT). Background parenchymal enhancement (BPE) changes in the contralateral breast were assessed according to adjuvant therapy by using the McNemar test. Results Of 11 detected cancers, six were seen at MR imaging only, one was seen at MR imaging and mammography, two were seen at MR imaging and US, one was seen at mammography only, and one was seen at PET/CT only. Three MR imaging-depicted cancers were observed at the original tumor bed, and two MR imaging-depicted cancers were observed adjacent to the original tumor. Among two false-negative MR imaging diagnoses (two cases of ductal carcinoma in situ), one cancer had manifested as calcifications at mammography without differentiated enhancement at MR imaging, and the other cancer was detected at PET/CT, but MR imaging results were negative because of marked BPE, which resulted in focal lesion masking. The positive predictive value of biopsy and the sensitivity, specificity, accuracy, and area under the curve for MR imaging were 32.1% (nine of 28), 81.8% (nine of 11), 95.1% (391 of 411), 94.7% (400 of 422), and 0.88, respectively. The sensitivity of surveillance MR imaging (81.8%; 95% confidence interval [CI]: 48.2%, 97.7%) was higher than that of mammography (18.2%; 95% CI: 2.3%, 51.8%) and US (18.2%; 95% CI: 2.3%, 51.8%), with an overlap in CIs. The BPE showed a significant decrease in the group of patients who received adjuvant chemotherapy (43 BPE decreases and four BPE increases) and the group of patients who received hormone therapy (55 BPE decreases and two BPE increases) (P < .0001 for both). Conclusion Early MR imaging surveillance after breast conservation therapy can be useful in patients who have breast cancer, with superior sensitivity compared with that of mammography and US. The BPE tends to be decreased at short-term follow-up MR imaging in patients who receive adjuvant therapy. © RSNA, 2017.

Correlation of the clinical parameters with sonographic findings of hemorrhagic cystitis in pediatric hematooncology patients.

To find a relationship between clinical and sonographic appearance of hemorrhagic cystitis (HC) in pediatric hematooncology patients. Clinical and sonographic findings of 31 children (M:F = 18:13; mean age, 12.7 years) with HC in pediatric hematooncology patients were reviewed. For each patient, the onset of HC after transplantation, use of bladder-toxic agent, presence of BK viruria, and duration of disease were reviewed. Sonographic findings including bladder wall thickness (BWT), the type of bladder wall thickening (nodular vs. diffuse), occurrence of hydronephrosis or pyelonephritis were reviewed. We analyzed sonographic appearance and clinical manifestations of HC. HC occurred within 4 months after HSCT/BMT. 27 patients (87.0 %) were positive for BK viruria and 24 patients (77.4 %) took bladder-toxic agents. On sonography, nodular type bladder wall thickening was more frequent (54.8 %), and BWT was thicker in this group (p = 0.003). There was a positive correlation between the BWT on initial sonography and duration of cystitis (r (2) = 0.340). Hydronephrosis developed in 25.8 % of patients with HC, and as HC persisted longer, hydronephrosis occurred more (p = 0.004). In patients with HC after HSCT/BMT, the BWT on initial sonography correlates well with the duration of cystitis. And, longer time of HC develops the risk of hydronephrosis.