Clinical Utility of Genomic Recurrence Risk Stratification in Early, Hormone-Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer: Real-World Experience.

BACKGROUND: RNA-based genomic risk assessment estimates chemotherapy benefit in patients with hormone-receptor positive (HR+)/Human Epidermal Growth Factor 2-negative (ERBB2-) breast cancer (BC). It is virtually used in all patients with early HR+/ERBB2- BC regardless of clinical recurrence risk. PATIENTS AND METHODS: We conducted a retrospective chart review of adult patients with early-stage (T1-3; N0; M0) HR+/ERBB2- BC who underwent genomic testing using the Oncotype DX (Exact Sciences) 21-genes assay. Clinicopathologic features were collected to assess the clinical recurrence risk, in terms of clinical risk score (CRS) and using a composite risk score of distant recurrence Regan Risk Score (RRS). CRS and RRS were compared to the genomic risk of recurrence (GRS). RESULTS: Between January 2015 and December 2020, 517 patients with early-stage disease underwent genomic testing, and clinical data was available for 501 of them. There was statistically significant concordance between the 3 prognostication methods (P < 0.01). Within patients with low CRS (n = 349), 9.17% had a high GRS, compared to 8.93% in patients with low RRS (n = 280). In patients with grade 1 histology (n = 130), 3.85% had a high GRS and 68.46% had tumors > 1 cm, of whom only 4.49% had a high GRS. Tumor size > 1cm did not associate with a high GRS. CONCLUSION: Genomic testing for patients with grade 1 tumors may be safely omitted, irrespective of size. Our finds call for a better understanding of the need for routine genomic testing in patients with low grade/low clinical risk of recurrence.

Diagnostic value of 3.0 T versus 1.5 T MRI in staging prostate cancer: systematic review and meta-analysis.

Purpose: To compare the diagnostic performance of 3.0 T and 1.5 T MRI in the staging of prostate cancer. Material and methods: English-language studies on the diagnostic accuracy of 3.0 T and 1.5 T MRI in prostate cancer staging published through May 2020 were searched for in relevant databases. The focus was on studies in which both 3.0 T and 1.5 T MRI were performed in the study population, to reduce interstudy heterogeneity. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve were determined for 3.0 T and for 1.5 T along with 95% confidence intervals (CIs). Results: Out of 8 studies identified, 4 met the inclusion criteria. 3.0 T (n = 160) had a pooled sensitivity of 69.5% (95% CI: 56.4-80.1%) and a pooled specificity of 48.8% (95% CI: 6.0-93.4%), while 1.5 T (n = 139) had a pooled sensitivity of 70.6% (95% CI: 55.0-82.5%; p = 0.91) and a pooled specificity of 41.7% (95% CI: 6.2-88.6%; p = 0.88). The pooled DOR for 3.0 T was 3 (95% CI: 0-26.0%), while the pooled DOR for 1.5 T was 2 (95% CI: 0-18.0%), which was not a significant difference (p = 0.89). Conclusions: 3.0 T has slightly better diagnostic performance than 1.5 T MRI in prostate cancer staging (3 vs. 2), although without statistical significance. Our findings suggest the need for larger, randomized trials directly comparing 3.0 T and 1.5 T MRI in prostate cancer.

Impact of low injected activity on data driven respiratory gating for PET/CT imaging with continuous bed motion.

Data driven respiratory gating (DDG) in positron emission tomography (PET) imaging extracts respiratory waveforms from the acquired PET data obviating the need for dedicated external devices. DDG performance, however, degrades with decreasing detected number of coincidence counts. In this paper, we assess the clinical impact of reducing injected activity on a new DDG algorithm designed for PET data acquired with continuous bed motion (CBM_DDG) by evaluating CBM_DDG waveforms, tumor quantification, and physician's perception of motion blur in resultant images. Forty patients were imaged on a Siemens mCT scanner in CBM mode. Reduced injected activity was simulated by generating list mode datasets with 50% and 25% of the original data (100%). CBM_DDG waveforms were compared to that of the original data over the range between the aortic arch and the center of the right kidney using the Pearson correlation coefficient (PCC). Tumor quantification was assessed by comparing the maximum standardized uptake value (SUVmax) and peak SUV (SUVpeak) of reconstructed images from the various list mode datasets using elastic motion deblurring (EMDB) reconstruction. Perceived motion blur was assessed by three radiologists of one lesion per patient on a continuous scale from no motion blur (0) to significant motion blur (3). The mean PCC of the 50% and 25% dataset waveforms was 0.74 ± 0.18 and 0.59 ± 0.25, respectively. In comparison to the 100% datasets, the mean SUVmax increased by 2.25% (p = 0.11) for the 50% datasets and by 3.91% (p = 0.16) for the 25% datasets, while SUVpeak changes were within ±0.25%. Radiologist evaluations of motion blur showed negligible changes with average values of 0.21, 0.3, and 0.28 for the 100%, 50%, and 25% datasets. Decreased injected activities degrades the resultant CBM_DDG respiratory waveforms; however this decrease has minimal impact on quantification and perceived image motion blur.

Extra-Nodal, Nasal, Natural Killer T-Cell Lymphoma Treated With a Checkpoint Inhibitor: A Case Report of a Sustained Complete Response.

Extra-nodal natural killer T-cell lymphoma (ENKTL) is a rare and aggressive hematologic malignancy found in the nasal cavity and adjacent locations in 80% of cases, accounting for approximately 10% of non-Hodgkin lymphoma (NHL) and 0.4% of all cancers. Prognosis is typically poor and depends on stage, location, age, and tumor markers for targeted therapy, which is reserved for relapsed/refractory ENKTL. Of those, advanced clinical stage, higher Prognostic Index (PI), nodal involvement, Ki-67 expression, large cells, local tumor invasiveness, and circulating Epstein-Barr virus (EBV)-DNA levels are predictive of worse survival. Here, we present a rare case of a patient in remission 30 months after diagnosis of ENKTL following a sustained complete response to pembrolizumab, an immune checkpoint inhibitor targeting the programmed death-1 (PD-1) receptor.

Diagnostic Performance of MRI to Differentiate Uterine Leiomyosarcoma from Benign Leiomyoma: A Meta-Analysis.

PURPOSE: To perform a meta-analysis comparing the diagnostic performance of increased signal intensity on T1- and T2-weighted magnetic resonance images and apparent diffusion coefficient (ADC) values in differentiating uterine leiomyosarcoma (LMS) from benign leiomyoma (LM). METHODS: A systematic literature search for original studies was performed using PubMed/MEDLINE, the Cochrane Library, Embase, and Web of Science. Data necessary for the meta-analysis was extracted from the selected articles and analyzed. RESULTS: Eight studies with 795 patients met our predefined inclusion criteria and were included in the analysis. Increased signal on T1-weighted imaging had a pooled sensitivity of 56.8% (95% CI: 20%-87.4%) for LMS (n = 60) which was significantly higher than 7.6% (95% CI: 2.2%-22.7%) for LM (n = 1272) (p = 0.0094). Increased signal analysis on T2-weighted imaging had a pooled sensitivities of 93.2% and 93.2% (95% CI: 45.7%-99.6% and 42.9%-99.6%) for LMS (n = 90), which were not significantly different from the 54.5% and 53.9% (95% CI: 33.6%-74%, 32%-74%) for LM (n = 215) (p = 0.102 and 0.112). On ADC value analysis, LMS (n = 43) had a weighted mean and standard deviation of 0.896 ± 0.19 10-3 mm2/s, 0.929 ± 0.182 10-3 mm2/s, which were significantly lower from 1.258 ± 0.303 10-3 mm2/s, 1.304 ± 0.303 10-3 mm2/s for LM (n = 159) (p = < 0.0001, < 0.0001). CONCLUSION: Our meta-analysis demonstrated that high signal intensity on T1-weighted images and low ADC values can accurately differentiate LMS from LM. Although, LMS had a higher pooled sensitivity for T2-weighted increased signal intensity compared to LM, there was no statistical significance.

Correction to: Imaging spectrum of mesenteric masses.

The original version of this article unfortunately contained a mistake. The author list was not correct in the original article. The missing co-author's name, Sherif Elsheif, has been added to show the correct and complete author list. All authors and the Editor-in-Chief agreed to the corrected author list. The original article has been corrected.

Imaging spectrum of mesenteric masses.

Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.

Hepatic Hemangioendothelioma: An update.

Primary epithelioid hemangioendotheliomas of the liver (EHL) are rare tumors with a low incidence. The molecular background of EHL is still under investigation, with WWTR1-CAMPTA1 mutation may function as a tumor marker. Commonly, this tumor is misdiagnosed with angiosarcoma, cholangiocarcinomas, metastatic carcinoma, and hepatocellular carcinoma (sclerosing variant). Characteristic features on imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography/computed tomography guide in diagnosis and staging. The "halo sign" and the "lollipop sign" on computed tomography and magnetic resonance imaging are described in the literature. Currently, there are no standardized guidelines for treating EHL with treatment options are broad including: chemotherapy, ablation, surgery and liver transplantation with inconsistent results.

Role of the Nox4/AMPK/mTOR signaling axe in adipose inflammation-induced kidney injury.

Diabetic kidney disease is one of the most serious complications of diabetes worldwide and is the leading cause of end-stage renal disease. While research has primarily focused on hyperglycemia as a key player in the pathophysiology of diabetic complications, recently, increasing evidence have underlined the role of adipose inflammation in modulating the development and/or progression of diabetic kidney disease. This review focuses on how adipose inflammation contribute to diabetic kidney disease. Furthermore, it discusses in detail the underlying mechanisms of adipose inflammation, including pro-inflammatory cytokines, oxidative stress, and AMPK/mTOR signaling pathway and critically describes their role in diabetic kidney disease. This in-depth understanding of adipose inflammation and its impact on diabetic kidney disease highlights the need for novel interventions in the treatment of diabetic complications.

Characterization of continuous bed motion effects on patient breathing and respiratory motion correction in PET/CT imaging.

Continuous bed motion (CBM) was recently introduced as an alternative to step-and-shoot (SS) mode for PET/CT data acquisition. In CBM, the patient is continuously advanced into the scanner at a preset speed, whereas in SS, the patient is imaged in overlapping bed positions. Previous investigations have shown that patients preferred CBM over SS for PET data acquisition. In this study, we investigated the effect of CBM versus SS on patient breathing and respiratory motion correction. One hundred patients referred for PET/CT were scanned using a Siemens mCT scanner. Patient respiratory waveforms were recorded using an Anzai system and analyzed using four methods: Methods 1 and 2 measured the coefficient of variation (COV) of the respiratory cycle duration (RCD) and amplitude (RCA). Method 3 measured the respiratory frequency signal prominence (RSP) and method 4 measured the width of the HDChest optimal gate (OG) window when using a 35% duty cycle. Waveform analysis was performed over the abdominothoracic region which exhibited the greatest respiratory motion and the results were compared between CBM and SS. Respiratory motion correction was assessed by comparing the ratios of SUVmax, SUVpeak, and CNR of focal FDG uptake, as well as Radiologists' visual assessment of corresponding image quality of motion corrected and uncorrected images for both acquisition modes. The respiratory waveforms analysis showed that the RCD and RCA COV were 3.7% and 33.3% lower for CBM compared to SS, respectively, while the RSP and OG were 30.5% and 2.0% higher, respectively. Image analysis on the other hand showed that SUVmax, SUVpeak, and CNR were 8.5%, 4.5%, and 3.4% higher for SS compared to CBM, respectively, while the Radiologists' visual comparison showed similar image quality between acquisition modes. However, none of the results showed statistically significant differences between SS and CBM, suggesting that motion correction is not impacted by acquisition mode.

Impact of free-breathing CT on quantitative measurements of static and quiescent period-gated PET Images.

Measurements of standardized uptake values (SUV) can vary due to many causes, including respiratory motion. Various methodologies have been introduced to correct for motion in PET, with quiescent-period-gated (QPG) PET being the most popular approach. QPG has been shown to improve PET image quantification compared to static-whole-body (SWB) PET. However, to achieve this improvement, QPG PET requires CT attenuation correction data that matches the QPG PET data. In this paper we investigated the effect of using free-breathing CT for attenuation correction of QPG PET on SUVmax and SUVpeak and compared the results to those of SWB PET. 34 lesions in 27 patients were included. All patients were injected with F-18 FDG. 4D-CT datasets representing all possible phases of respiration that could result from a free-breathing CT were acquired. The 4D-CT datasets were used for attenuation correction of the QPG and SWB PET data. Percentage change in the SUVmax and SUVpeak range was calculated for the reconstructions and compared between QPG and SWB PET. The mean percentage change in the lesion SUVmax and SUVpeak ranges were 19.1% (p  = 0.0178) and 25.2% (p  = 0.0002) higher for QPG compared to SWB, respectively. The maximum percent change in SUVmax and SUVpeak ranges were 58.5% and 59.0% for QPG, respectively compared to 46.1% and 45.3% for SWB, respectively. The highest SUVmax and SUVpeak measurements corresponded to the CT phase that matched the QPG phase. Utilizing free-breathing CT for attenuation correction can lead to large changes in quantification due to misalignment with PET data. This misalignment has a large quantitative impact on QPG PET as compared to SWB PET. When interpreting quantitative changes in lesions, it is critical to consider the influences of free-breathing CT-based attenuation correction.