The characteristics associated with upgrade on surgical pathology of conventional imaging occult DCIS diagnosed by MRI.

PURPOSE: To characterize the clinical, pathological, and imaging features of DCIS occult on conventional imaging diagnosed on MRI-guided biopsy associated with increased risk of invasive disease on surgical excision. MATERIALS AND METHODS: All consecutive patients with MRI-detected DCIS occult on conventional imaging between January 2009 and December 2018 were included. Women were divided into two groups based on final pathology: Pure DCIS or DCIS with invasive component. Clinical, imaging, and pathological risk factors for upgrade to invasion were evaluated. RESULTS: Of 50 patients who met the inclusion criteria, 12 (24%) were upgraded to invasive malignancy in the final pathology. The only parameters that showed statistically significant association with upgrade were related to kinetic characteristics: 53% of patients with the combination of fast early upstroke and either plateau or washout curve were upgraded, compared to 12% of women without this combination (p = 0.006). The sensitivity of combined kinetic features for predicting upgrade was 67% (95% CI 35-90%), specificity was 84% (CI 95% 68-94%), positive predictive value was 57% (CI 95% 37-75%), negative predictive value was 89% (CI 95% 77-95%), and OR was 78% (64-88%). CONCLUSION: Kinetic characteristics show the strongest association with upgrade to invasion in DCIS occult on mammogram and US. Larger studies should be encouraged to consolidate our findings, which may have implication for treatment planning.

Imaging Features of Inflammatory Breast Disorders: A Pictorial Essay

Inflammatory breast disorders include a wide array of underlying causes, ranging from common benign infection, non-infectious inflammation and inflammation resulting from underlying breast malignancy. Because it is at times difficult to distinguish mastitis and breast cancer based on clinical features, awareness of detailed imaging features may be helpful for better management of inflammatory breast disorders. Therefore, this pictorial essay intends to demonstrate radiologic findings of a variety of inflammatory breast disorders, using selected cases with mammography, ultrasound and magnetic resonance images.

Routine Staging Using Chest Computed Tomography in Workup of Treatment-Naïve Hepatocellular Carcinoma Prior to Locoregional Therapy: Is There a Need?

<p><b>INTRODUCTION</b>The lung is the most common site of distal metastasis in patients with hepatocellular carcinoma (HCC), as seen in more than half of patients with extrahepatic disease. The incidence of pulmonary metastasis in all patients with HCC, however, remains low (between 4.5% to 20%). Their presence, nevertheless, contraindicates curative locoregional therapies. The role of staging chest computed tomography (CT) before locoregional treatment is not well defined. This study aimed to assess the utility of pre-treatment chest CT prior to locoregional therapy.</p><p><b>MATERIALS AND METHODS</b>Retrospective review of continuous cases of treatment-naïve HCC referred for locoregional therapy from 2004 to 2013 was performed. Patients with pre-treatment chest CT were evaluated for the presence of pulmonary metastases. HCC features (size, numbers, vascular invasion, nodal status and bone metastases) were recorded. Univariate analysis and multivariate logistic regression were performed for significant association.</p><p><b>RESULTS</b>A total of 780 patients were reviewed, of which 135 received staging chest CT. Pulmonary metastases (n = 17, 12.6%), benign lesions (n = 41, 30.4%) and indeterminate lesions (n = 11, 8.1%) were detected. Among the indeterminate lesions, there were losses to follow-up (n = 2) and deaths within the study period (n = 3). All patients with pulmonary metastases were declined locoregional therapy. Univariate analysis showed statistical significant association between pulmonary metastases with the number of intrahepatic lesions (<0.01), primary tumour size (= 0.018) and presence of vascular invasion (<0.01). On multivariate analysis, the number of intrahepatic lesions (OR: 9.7; 95% CI, 1.6 to 57.2;= 0.012) and presence of both hepatic and portal venous invasions (OR: 11.8; 95% CI, 1.1 to 128.8;= 0.043) were the 2 independent positive predictors of pulmonary metastases.</p><p><b>CONCLUSION</b>The prevalence of pulmonary metastasis is low in HCC and our study does not support the routine use of staging chest CT in all treatment-naïve patients. It can, however, be considered in cases with multiple lesions or vascular invasion.</p>