Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I–III axillary as well as cervical lymphadenopathy. ...Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.
Breast cryoablation for palliative and curative treatment of breast cancer has been performed for decades. Although there is a recent resurgence of interest in breast cryoablation with curative ...intent for unifocal, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, this report highlights the essential role that cryoablation can play in the palliative treatment of multicentric oestrogen and progesterone receptor-negative and human epidermal growth factor receptor 2-negative (triple-negative) breast cancer, meeting the select pretreatment objectives such as breast or nipple pain relief and prevention of tumour erosion through the skin or nipple in patients who have failed or cannot tolerate the standard of care treatment.
Objective
This study was designed to determine the histopathologic correlation at surgery of residual mammographic calcifications in patients after neoadjuvant chemotherapy (NAC) for locally advanced ...breast cancer (LABC).
Methods
This single-institution, retrospective study was approved by the Institutional Review Board and was Health Insurance Portability and Accountability act compliant. Women with LABC who underwent NAC between January 1, 2004 and December 31, 2008 and had mammography performed before and after NAC available for review were included in this study. The extent of microcalcifications associated with cancer before and after the completion of NAC was correlated with histopathology and biomarker status.
Results
Of 494 patients who met the inclusion criteria, 106 demonstrated microcalcifications on pre-, post-chemotherapy, or both sets of mammograms and were included in this study. Of 106 women, 31 (29 %) had invasive ductal carcinoma (IDC) and 60 (57 %) had both IDC and ductal carcinoma in situ (DCIS). Microcalcifications decreased or remained stable in 76 (72 %) patients after completion of NAC. Correlation of microcalcifications with histopathology after NAC showed that 43 (40.6 %) patients had tumors associated with benign pathology. Of 32 patients with pathologic complete response, calcifications were associated with DCIS in 9 (9 %) and benign findings in 21 (22 %). The proportion of residual malignant calcifications was higher in ER+ versus ER− patients after NAC.
Conclusions
The extent of calcifications on mammography following NAC does not correlate with the extent of residual disease in up to 22 % of women; this information may impact surgical planning in subsets of women with breast cancer.
Background
Targeted axillary dissection (TAD) involves locating and removing both clipped nodes and sentinel nodes for assessment of the axillary response to neoadjuvant chemotherapy (NAC) by ...clinically node-positive breast cancer patients. Initial reports described radioactive seeds used for localization, which makes the technique difficult to implement in some settings. This trial was performed to determine whether magnetic seeds can be used to locate clipped axillary lymph nodes for removal.
Methods
This prospective registry trial enrolled patients who had biopsy-proven node-positive disease with a clip placed in the node and treatment with NAC. A magnetic seed was placed under ultrasound guidance in the clipped node after NAC. All the patients underwent TAD.
Results
Magnetic seeds were placed in 50 patients by 17 breast radiologists. All the patients had successful seed placement at the first attempt (mean time for localization was 6.1 min; range 1–30 min). The final position of the magnetic seed was within the node (
n
= 44, 88%), in the cortex (
n
= 3, 6%), less than 3 mm from the node (
n
= 2, 4%), or by the clip when the node could not be adequately visualized (
n
= 1, 2%). The magnetic seed was retrieved at surgery from all the patients. In 49 (98%) of the 50 cases, the clip and magnetic seed were retrieved from the same node. Surgeons rated the transcutaneous and intraoperative localization as easy for 43 (86%) of the 50 cases. No device-related adverse events occurred.
Conclusions
Localization and selective removal of clipped nodes can be accomplished safely and effectively using magnetic seeds.
This article describes the use of sonography for the locoregional staging of breast cancer. Sonography may identify mammographically occult disease within the breast. Sonography of the regional nodal ...basins, including the axilla, infraclavicular, supraclavicular, and internal mammary regions, can identify nodal metastases, which may upstage disease and have implications for prognosis.
The anatomy of the regional nodal basins and the TNM staging system for breast cancer are reviewed, and the implications of ultrasound-detected disease on clinical management and treatment decisions are discussed.
To retrospectively evaluate the imaging findings of breast lymphomas in patients who had undergone mammography, ultrasonography (US), magnetic resonance (MR) imaging, or combined positron emission ...tomography (PET)/computed tomography (CT) scanning.
The institutional review board approved this HIPAA-compliant study and waived informed consent. Twenty-seven women who had been diagnosed with breast lymphoma (32 tumors) and had undergone preoperative imaging were identified from the surgical pathology database (mean age, 51 years; median, 55 years; range, 19-78 years at time of diagnosis). Two radiologists reviewed the mammographic, US, and MR images. One nuclear medicine physician reviewed the PET/CT scans. All available pathologic specimens were reviewed by a hematologic pathologist.
The mean tumor size at diagnosis was 2.9 cm (range, 1-5 cm). Seventeen tumors manifested with a palpable mass, two with diffuse enlargement of the breast, and 13 were asymptomatic. Twenty-two women underwent mammography; 24, US; one, MR imaging; and 10, PET/CT scanning. Mammograms of 25 tumors showed a noncalcified mass in 19, global asymmetry in four, focal asymmetry in one, and no abnormality in one. US of 29 tumors showed a mass in 26 and diffuse architectural distortion in three. Masses typically were irregular, hypoechoic, and hypervascular and demonstrated indistinct margins or an echogenic boundary. Dynamic contrast material-enhanced MR imaging of one tumor showed an intensely and heterogeneously enhancing mass with rapid enhancement and washout characteristics. PET/CT scans of 13 tumors showed intense diffuse hypermetabolism in 12 and response to therapy in all 12 tumors.
The imaging findings reported in this study should alert the radiologist to a possible diagnosis of breast lymphoma.
Early assessment of neoadjuvant systemic therapy (NAST) response for triple-negative breast cancer (TNBC) is critical for patient care in order to avoid the unnecessary toxicity of an ineffective ...treatment. We assessed functional tumor volumes (FTVs) from dynamic contrast-enhanced (DCE) MRI after 2 cycles (C2) and 4 cycles (C4) of NAST as predictors of response in TNBC. A group of 100 patients with stage I-III TNBC who underwent DCE MRI at baseline, C2, and C4 were included in this study. Tumors were segmented on DCE images of 1 min and 2.5 min post-injection. FTVs were measured using the optimized percentage enhancement (PE) and signal enhancement ratio (SER) thresholds. The Mann-Whitney test was used to compare the performance of the FTVs at C2 and C4. Of the 100 patients, 49 (49%) had a pathologic complete response (pCR) and 51 (51%) had a non-pCR. The maximum area under the receiving operating characteristic curve (AUC) for predicting the treatment response was 0.84 (
< 0.001) for FTV at C4 followed by FTV at C2 (AUC = 0.82,
< 0.001). The FTV measured at baseline was not able to discriminate pCR from non-pCR. FTVs measured on DCE MRI at C2, as well as at C4, of NAST can potentially predict pCR and non-pCR in TNBC patients.
This study aimed to investigate mid-treatment breast tumor ultrasound characteristics that may predict eventual pathologic complete response (pCR) in triple-negative breast cancer; specifically, we ...examined associations between pCR and two parameters: tumor response pattern and tumor appearance. Ultrasound was performed at mid-treatment, defined as the completion of four cycles of anthracycline-based chemotherapy and before receiving taxane-based chemotherapy. Consensus imaging review was performed while blinded to pathology results (i.e., pCR/non-pCR) from surgery. Tumor response pattern was described as "complete," "concentric," "fragmented," "stable" or "progression." Tumor appearance was designated as "mass," "architectural distortion," "flat tumor bed" or "clip only." Univariate and multivariate regression analyses of 144 participants showed significant associations between mid-treatment response pattern and pCR (p = 0.0348 and p = 0.0173, respectively), with complete and concentric response patterns more likely to achieve pCR than other patterns. Univariate and multivariate regression analyses further showed significant associations between mid-treatment tumor appearance and pCR (p < 0.0001 for both), with persistent appearance of mass less likely than other appearances to achieve pCR. To conclude, our study demonstrated strong associations between pCR and both tumor response pattern and tumor appearance, thereby suggesting that these parameters have potential as qualitative imaging biomarkers of pCR in triple-negative breast cancer.
Background
Dynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves ...in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response.
Purpose
To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple‐negative breast cancer (TNBC).
Study Type
Prospective.
Population/Subjects
Sixty patients with biopsy‐confirmed TNBC between December 2016 and September 2020.
Field Strength/Sequence
A 3.0 T/3D fast spoiled gradient echo‐based DCE MRI
Assessment
Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5‐minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing.
Statistical Tests
Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann–Whitney U test.
Results
About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non‐pCR, with AUC (95% confidence interval CI) = 0.85 (0.74,0.95) (P < 0.05). The 1‐minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05).
Data Conclusion
FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC.
Level of Evidence
1
Technical Efficacy
4
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