Multiparametric ultrasound examination for response assessment in breast cancer patients undergoing neoadjuvant therapy.

To investigate the performance of multiparametric ultrasound for the evaluation of treatment response in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The IRB approved this prospective study. Breast cancer patients who were scheduled to undergo NAC were invited to participate in this study. Changes in tumour echogenicity, stiffness, maximum diameter, vascularity and integrated backscatter coefficient (IBC) were assessed prior to treatment and 7 days after four consecutive NAC cycles. Residual malignant cell (RMC) measurement at surgery was considered as standard of reference. RMC < 30% was considered a good response and > 70% a poor response. The correlation coefficients of these parameters were compared with RMC from post-operative histology. Linear Discriminant Analysis (LDA), cross-validation and Receiver Operating Characteristic curve (ROC) analysis were performed. Thirty patients (mean age 56.4 year) with 42 lesions were included. There was a significant correlation between RMC and echogenicity and tumour diameter after the 3rd course of NAC and average stiffness after the 2nd course. The correlation coefficient for IBC and echogenicity calculated after the first four doses of NAC were 0.27, 0.35, 0.41 and 0.30, respectively. Multivariate analysis of the echogenicity and stiffness after the third NAC revealed a sensitivity of 82%, specificity of 90%, PPV = 75%, NPV = 93%, accuracy = 88% and AUC of 0.88 for non-responding tumours (RMC > 70%). High tumour stiffness and persistent hypoechogenicity after the third NAC course allowed to accurately predict a group of non-responding tumours. A correlation between echogenicity and IBC was demonstrated as well.

Usefulness of combined BI-RADS analysis and Nakagami statistics of ultrasound echoes in the diagnosis of breast lesions.

AIM: To develop a method combining the statistics of the ultrasound backscatter and the Breast Imaging-Reporting and Data System (BI-RADS) classification to enhance the differentiation of breast tumours. MATERIALS AND METHODS: The Nakagami shape parameter m was used to characterise the scatter properties of breast tumours. Raw data from the radiofrequency (RF) echo-signal and B-mode images from 107 (32 malignant and 75 benign) lesions and their surrounding tissue were recorded. Three different characteristic values of the shape parameters of m (maximum [mLmax], minimum [mLmin] and average [mLavg]) and differences between m parameters (Δmmax, Δmmin, Δmavg) of the lesions and their surrounding tissues were assessed. A lesion with a BI-RADS score of 3 was considered benign, while a lesion with a score of 4 was considered malignant (a cut-off of BI-RADS 3/4 was set for all patients). RESULTS: The area under the receiver operating characteristic (ROC) curve (AUC) was equal to 0.966 for BI-RADS, with 100% sensitivity and 54.67% specificity. All malignant lesions were diagnosed correctly, whereas 34 benign lesions were biopsied unnecessarily. In assessing the Nakagami statistics, the sum of the sensitivity and specificity was the best for mLavg (62.5% and 93.33%, respectively). Only four of 20 lesions were found over the cut-off value in BI-RADS of 4a. When comparing the differences in m parameters, Δmavg had the highest sensitivity of 90% (only three of 32 lesions were false negative). These three lesions were classified as BI-RADS category 4c. The combined use of B-mode and mLmin parameter improve the AUC up to 0.978 (p=0.088), compared to BI-RADS alone. CONCLUSION: The combination of the parametric imaging and the BI-RADS assessment does not significantly improve the differentiation of breast lesions, but it has the potential to better identify the group of patients with mainly benign lesions that have a low level of suspicion for malignancy with a BI-RADS score of 4a.

Carcinomas and sarcomas of Bartholin gland. A report of nine cases and review of the literature.

UNLABELLED: The greater vestibular gland, also called Bartholin's gland after the Danish anatomist Caspar Bartholin the Younger who first described it in the 17th century, is the site of tumours arising from different types of epithelium and characterized by a different clinical course. In the years 1980-2009, 1,296 patients with vulvar carcinoma were treated at the Oncology Centre in Warsaw, Poland and nine of them had carcinoma of Bartholin's gland, including three patients with squamous cell carcinoma (SCC), three patients with adenoid cystic carcinoma (ACC) and three patients with sarcoma. In this paper the authors present the signs and symptoms, clinical course, treatment outcomes, and recurrence of these three malignant tumours of different histopathology. Own observations and evaluation of treatment results are compared with published reports from other centres. Interestingly, there is no consensus regarding diagnostic criteria or a uniform approach to management. Relatively poor knowledge of malignant tumours of Bartholin's gland seems to be responsible for delays in proper diagnosis and hence optimal management. When instituted, the treatment is usually aggressive and involves adjuvant radio- and chemotherapy, while the chances of longer disease-free survival after treatment may be compromised. CONCLUSION: Bartholin sarcomas grow fast and invasive, SCC, and ACC infiltrate slowly and systematic. All types are curable at high interest rates if they are originally from the surgically removed lymph nodes on both sides and irradiated.

The influence of theobromine on angiogenic activity and proangiogenic cytokines production of human ovarian cancer cells.

Angiogenesis plays an important role in ovarian cancer growth and metastasis formation. Adenosine is one of the most potent stimulator of neovascularisation. The aim of present study was to determine if theobromine, adenosine receptor antagonist, influences angiogenic activity and proangiogenic cytokines production. Theobromine caused significant inhibition of angiogenic activity of ovarian cancer cells. In in vivo and in vitro cultures theobromine diminished vascular endothelial growth factor (VEGF) production. Production of basic fibroblast growth factor (bFGF) and interleukin-8 (IL-8) was not altered by the examined drug. These findings suggest that theobromine might be a potent inhibitor of angiogenesis induced by ovarian cancer cells and its mechanism of action is related to inhibition of VEGF production.