A case of ALK-positive histiocytosis with multiple lesions in the unilateral breast: A case report.

INTRODUCTION AND IMPORTANCE: Primary ALK-positive histiocytosis of the breast is rare. Here, we report a case of ALK-positive histiocytosis with multiple unilateral breast lesions. CASE PRESENTATION: Our patient was a 38-year-old female with primary ALK-positive histiocytosis of the breast with multiple lesions. There were no lesions in other organs, and the patient was considered surgically resectable and underwent a left total mastectomy and sentinel lymph node biopsy. Histopathologically, there were at least three lesions in the left breast in upper inner quadrant (UIQ), upper quadrant (UQ), and upper outer quadrant (UOQ). All lesions showed spindle-shaped tumor cells that were positive for CD163 and ALK and negative for AE1/AE3. Fluorescence in situ hybridization (FISH) showed ALK and KIF5B rearrangements, suggesting the presence of the KIF5B-ALK fusion gene. In conclusion, this case was confirmed to be ALK-positive histiocytosis with multiple lesions in the unilateral breast. The patient underwent surgery and was discharged without complications. CLINICAL DISCUSSION: Reports of ALK-positive histiocytosis are very rare, and reports of primary cases in the breast are even rarer. The basic treatment for ALK-positive histiocytosis is surgical resection; however, ALK inhibitors may be effective in unresectable or disseminated cases. Accurate diagnosis at the time of initial treatment is necessary to expand the treatment options. CONCLUSION: This is the first case of ALK-positive histiocytosis with multiple lesions in the unilateral breast.

Preliminary experiences of PET/MRI in predicting complete response in patients with breast cancer treated with neoadjuvant chemotherapy.

Clinical response predictions through image examinations after neoadjuvant chemotherapy (NAC) for breast cancer is important. The present study aimed to evaluate the utility of a novel imaging modality, positron-emission tomography/magnetic resonance imaging (PET/MRI), in predicting the pathological complete response (pCR) to NAC in patients with early breast cancer. A total of 74 patients underwent PET/MRI, mammography (MG), including tomosynthesis, and ultrasound (US) after NAC. The complete response was predicted using each modality and these outcomes were compared accordingly. In terms of PET/MRI, complete response (CR) was defined as the disappearance of 18F-fluorodeoxyglucose uptake and the absence of enhanced lesions with contrast enhanced MRI. In MG and US, undetectable lesions were considered as CR. The background and tumor characteristics of patients were also analyzed between the pCR and non-pCR cases. Overall, 18 (24.3%) of the 74 patients achieved pCR. The overall sensitivity and specificity of PET/MRI were 72.2 and 78.6%, respectively. Both the sensitivity in hormone receptor (HR)-positive cases and the specificity in HR-negative cases were 100%. HR-negative and human epidermal growth factor receptor 2 (HER2)-positive cases demonstrated a significant association with pCR compared with HR-positive cases and triple negative cases (P=0.017). Furthermore, patients with 'mass' type lesions evaluated by MRI before NAC experienced pCR with a higher frequency than those with 'non-mass' type lesions. There was a statistically significant difference between the two groups (P=0.018). In conclusion, PET/MRI is a different diagnostic approach that utilizes a multi-modality system. It demonstrates reasonable diagnostic accuracies of the responses of NAC with reference to hormonal subtypes in breast cancer.

Diagnostic performance of digital breast tomosynthesis for predicting response to neoadjuvant systemic therapy in breast cancer patients: A comparison with magnetic resonance imaging, ultrasound, and full-field digital mammography.

BACKGROUND: The goals of neoadjuvant systemic therapy (NST) are to reduce tumor volume and to provide a prognostic indicator in assessing treatment response. Digital breast tomosynthesis (DBT) was developed and has increased interest in clinical settings due to its higher sensitivity for breast cancer detection compared to full-field digital mammography (FFDM). PURPOSE: To evaluate the accuracy of DBT in assessing response to NST compared to FFDM, ultrasound (US), and magnetic resonance imaging (MRI) in breast cancer patients. MATERIAL AND METHODS: In this retrospective study, 95 stages II-III breast cancer patients undergoing NST and subsequent surgeries were enrolled. After NST, the longest diameter of residual tumor measured by DBT, FFDM, US, and MRI was compared with pathology. Agreements and correlations of tumor size were assessed, and the diagnostic performance for predicting pathologic complete response (pCR) was evaluated. RESULTS: Mean residual tumor size after NST was 19.9 mm for DBT, 18.7 mm for FFDM, 16.0 mm for US, and 18.4 mm for MRI, compared with 17.9 mm on pathology. DBT and MRI correlated better with pathology than that of FFDM and US. The ICC values were 0.85, 0.87, 0.74, and 0.77, respectively. Twenty-five patients (26.3%) achieved pCR after NST. For predicting pCR, area under the receiver operating characteristic (ROC) curve for DBT, FFDM, US, and MRI were 0.79, 0.66, 0.68, and 0.77, respectively. CONCLUSION: DBT has good correlation with histopathology for measuring residual tumor size after NST. DBT was comparable to MRI in assessing tumor response after completion of NST.

Comparative analysis between synthetic mammography reconstructed from digital breast tomosynthesis and full-field digital mammography for breast cancer detection and visibility.

PURPOSE: To compare observer performance between synthetic mammography (2DSM) and full-field digital mammography (FFDM) for breast cancer detection and visibility. METHOD: A retrospective analysis was conducted on 136 histopathologically proven cases of breast cancer in patients who underwent FFDM and digital breast tomosynthesis (DBT). 2DSM images were reconstructed from DBT data, and 2DSM and FFDM images were reviewed and evaluated for mammographic features, probability of malignancy (BI-RADS classification), and lesion conspicuity. DBT images were not reviewed. Statistical differences in cancer detection rates between 2DSM and FFDM images were analyzed using the McNemar test, agreement on BI-RADS assessment between 2DSM and FFDM was assessed using Cohen's kappa test, and the Wilcoxon's signed rank test was used to compare visibility scores. RESULTS: Mean cancer detection rates with 2DSM and FFDM images were 84.6 % and 87.8 %, respectively. In subgroup analyses, differences in breast density, tumor size, and presence of calcifications were not statistically significant. Agreement between 2DSM and FFDM images for BI-RADS classification was graded as good with Cohen's k-coefficient of 0.78 ±â€¯0.05. Visibility scores in both modalities of images were similar for all lesions combined; however, 2DSM had significantly better visibility scores for calcified cancers (p < 0.01), and in dense breast tissue (p < 0.01). CONCLUSIONS: Diagnostic performances of 2DSM and FFDM images were comparable for detecting breast cancers, and it is possible that 2DSM may eliminate the need for additional FFDM during DBT-based imaging due to advances in image reconstruction methods.

Locally advanced triple negative breast cancer arising from fibroadenoma with complete response to neoadjuvant chemotherapy: A case report.

INTRODUCTION: Breast cancer arising from benign fibroadenoma (FA) is rare. The histological type of the former was either carcinoma in situ or early-stage invasive breast carcinoma with hormone receptor positive/HER2 (human epidermal growth factor receptor-2)-negative phenotype. Meanwhile, advanced breast cancer of triple negative (TN) phenotype such as our case is extremely uncommon and clinically challenging. PRESENTATION OF CASE: We experienced a case of a 53-year-old woman that had invasive ductal carcinoma of TN phenotype in FA with multiple lymph node metastases. After receiving neoadjuvant chemotherapy (NAC), she underwent breast mastectomy and axillary dissection. The pathological examination on postoperative specimens revealed the dense fibrous stroma in the FA without any residual viable tumor cells and was considered as pathological complete response (pCR). DISCUSSION: This is the first report presenting a case of NAC treatment for invasive ductal carcinoma (IDC) in FA. Furthermore, the patient achieved pCR even if IDC was located within FA. Diagnosing breast cancer in FA may be challenging as the carcinoma component may be hidden by the FA component. If imaging of FA became larger or abnormal changes during follow-up examinations, needle biopsy should be recommended for assessment of the lesion positively. CONCLUSION: This is the first report presenting a case of advanced breast cancer in FA of TN phenotype with multiple lymph node metastases who achieved pCR even if IDC was located within FA.

Current status of CAD utilizing digital mammography in Japan.

In this article, we describe the function of computer-aided detection (CAD), the history of CAD in mammography, its current status, the differences between CAD in analog mammography and digital mammography, detection performance, and appropriate directions for its use.

Digital mammographic screening in Japan.

We describe the current status of mammographic screening and investigate how digital mammography is used in screening in Japan. Despite the widespread use of digital mammographic equipment, the mammographic screening rate for invited women is very low. In the majority of cases, digital hard copy images are read for screening. Soft-copy reading of digital mammography is not widely used, because of the difficulty of handling large amounts of CR data, the cost of workstations with 5 M LCD monitors, and the loading of full-field digital mammography on the mobile unit. Digital mammography has a number of advantages and has increasingly replaced conventional film-screen mammography, becoming the gold standard in combination with soft-copy reading in screening settings.

[Evaluation of the 1Shot Phantom dedicated to the mammography system using FCR].

Currently daily quality control (QC) tests for mammography systems are generally evaluated by using visual analysis phantoms, which of course means subjective measurement. In our study, however, we evaluated a novel digital phantom, the 1Shot Phantom M plus (1Shot Phantom), together with automatic analysis software dedicated for mammography systems using Fuji computed radiography (FCR). The digital phantom enables objective evaluation by providing for actual physical measurement rather than subjective visual assessment. We measured 1) contrast to noise ratio (CNR), 2) image receptor homogeneity, 3) missed tissue at chest wall side, 4) modulation transfer function (MTF), and 5) geometric distortion utilizing the 1Shot Phantom. We then compared the values obtained using the 1Shot Phantom with values obtained from the European guidelines and International Electrotechnical Commission (IEC) standards. In addition, we evaluated the convenience of using the digital phantom. The values utilizing the 1Shot Phantom and those from the European guidelines and IEC standards were consistent, but the QC tests for the European guidelines and IEC standards methods took about six hours while the same QC tests using the 1Shot Phantom took 10 minutes or less including exposure of the phantom image, measurement, and analysis. In conclusion, the digital phantom and dedicated software proved very useful and produced improved analysis for mammography systems using FCR in clinical daily QC testing because of their objectivity and substantial time-saving convenience.

Diagnostic performance of detecting breast cancer on computed radiographic (CR) mammograms: comparison of hard copy film, 3-megapixel liquid-crystal-display (LCD) monitor and 5-megapixel LCD monitor.

The purpose was to compare observer performance in the detection of breast cancer using hard-copy film, and 3-megapixel (3-MP) and 5-megapixel (5-MP) liquid crystal display (LCD) monitors in a simulated screening setting. We amassed 100 sample sets, including 32 patients with surgically proven breast cancer (masses present, N = 12; microcalcifications, N = 10; other types, N = 10) and 68 normal controls. All the mammograms were obtained using computed radiography (CR; sampling pitch of 50 mum). Twelve mammographers independently assessed CR mammograms presented in random order for hard-copy and soft-copy reading at minimal 4-week intervals. Observers rated the images on seven-point (1 to 7) and continuous (0 to 100) malignancy scales. Receiver-operating-characteristics analysis was performed, and the average area under the curve (AUC) was calculated for each modality. The jackknife method with the Bonferroni correction was applied to multireader/multicase analysis. The average AUC values for the 3-MP LCD, 5-MP LCD, and hard-copy film were 0.954, 0.947, and 0.956 on the seven-point scale and 0.943, 0.923, and 0.944 on the continuous scale, respectively. There were no significant differences among the three modalities on either scale. Soft-copy reading using 3-MP and 5-MP LCDs is comparable to hard-copy reading for detecting breast cancer.

Vascular virtual endoluminal visualization of invasive colorectal cancer on MDCT colonography.

OBJECTIVE: The purpose of this study was to assess the utility of vascular views for visualization of invasive colorectal cancers on contrast-enhanced MDCT colonography. CONCLUSION: By means of Hounsfield-transparency settings, we obtained virtual endoluminal images that show vascular structures and delineate invasive cancers of the colorectal wall, and we call these images "vascular views." Using this technique for contrast-enhanced MDCT colonography, we found that the increase in flow and pooling of blood related to angiogenesis of cancerous lesions is easy to identify and that this finding is useful in the detection of invasive colorectal cancers.

Staging of malignant lymphoma with three-station black-blood fast short-inversion time inversion recovery (STIR).

PURPOSE: The purpose of this study was to assess the usefulness of three-station black-blood fast short-inversion time inversion recovery (STIR) imaging in detecting and staging malignant lymphoma. METHODS: Seventeen patients with malignant lymphoma were examined with a 1.5T imager. The findings and stagings determined with three-station black-blood fast STIR imaging were compared with reference standards (e.g., computed tomography [CT] findings and clinical stagings). RESULTS: Three-station black-blood fast STIR imaging provided a fat-suppressed T2-weighted imaging contrast with fewer flow artifacts and revealed nodal involvement as well as bone marrow and spleen involvement to an extent comparable with CT. Especially notable was the excellent specificity (94%) of this imaging technique. Regarding disease staging, significant agreement was observed between clinical staging (k=0.60) and staging as evaluated by three-station black-blood fast STIR, although the detection of lymphadenopathy in the thorax was relatively poor. The average time required for this imaging was approximately 30 min. CONCLUSION: Three-station black-blood fast STIR MR imaging may be useful as a staging tool for malignant lymphoma because this imaging technique reveals lymphoma lesions, which determine the staging, without radiation exposure or the use of contrast agents.