Current Status of Imaging for Breast Cancer Staging Pria, Hanna R. Ferreira Dalla; Scoggins, Marion E.; Moseley, Tanya W. ...
Current breast cancer reports,
06/2024, Letnik:
16, Številka:
2
Journal Article
Recenzirano
Purpose of Review
Breast cancer is the most common cancer among women. Accurate clinical staging is important as it guides management and treatment. The radiologist plays an important role in the ...evaluation of breast cancer because imaging is integral to clinical staging. This review aims to highlight the various aspects of staging breast cancer with an emphasis on the appropriate use of imaging.
Recent Findings
The 8th edition of the American Joint Commission on Cancer (AJCC) Staging Manual incorporates tumor markers and other prognostic factors, in addition to the traditional anatomic staging. This allows a more precise estimation of disease extent, allowing appropriate treatment and management of patients. Imaging plays an important role in accurately staging patients clinically. Different breast imaging modalities and systemic imaging modalities complement each other to give the most accurate clinical stage, which is then combined with biological and prognostic factors to guide patient management.
Summary
Understanding the staging of breast cancer is essential for the radiologist and allows for individualized and prognostic-based management of breast cancer patients.
The Benefits of Screening Mammography De Jesus, Charles; Moseley, Tanya W.; Diaz, Valentina ...
Current breast cancer reports,
06/2023, Letnik:
15, Številka:
2
Journal Article
Recenzirano
Purpose of Review
Breast cancer is the most commonly diagnosed cancer worldwide. Early detection through screening mammography has been proven to reduce mortality, morbidity, and years of life lost. ...The purpose of this review is to discuss the benefits of screening mammography and the latest recommendations from the American College of Radiology (ACR).
Recent Findings
Approximately 300,000 new cases of breast cancer are diagnosed in the USA yearly. Screening mammography has allowed for early cancer detection with increasing efficacy leading to 500 prevented deaths for every 100,000 women screened and a 5-year survival rate of 91%.
Summary
Mammography screening promotes the earlier detection of breast cancer, hence minimizing mortality, years of life lost, and treatment morbidity associated with advanced breast cancer at the time of diagnosis.
Supplemental Screening for Breast Cancer De Jesus, Charles; Moseley, Tanya W.; Diaz, Valentina ...
Current breast cancer reports,
06/2023, Letnik:
15, Številka:
2
Journal Article
Recenzirano
Purpose of Review
Increased breast density, among other calculated risk factors, decreases the sensitivity of screening mammography. Several supplementary imaging modalities including breast ...ultrasound, breast MRI, contrast-enhanced mammography (CEM), and molecular breast imaging (MBI) can be used in addition to screening mammograms to increase the sensitivity of cancer detection in above-average-risk women and will be discussed here.
Recent Findings
Ultrasound is the most widely used and accessible supplementary screening method that improves the cancer detection rate. MRI, the most sensitive supplemental breast imaging modality, is used to detect and visualize additional cancers in those with a lifetime risk of breast cancer at or greater than 20%. Small studies indicate that CEM has cancer detection rates equivalent to MRI; nevertheless, more evidence is needed to demonstrate its use. MBI has shown promise to be an adjunct to mammography for patients with dense breasts and for situations in which breast MRI is contraindicated
.
Despite this promising research, the American College of Radiology currently does not recommend the use of MBI for screening.
Summary
In women who have a higher-than-average risk of developing breast cancer, additional imaging modalities, such as breast ultrasound, breast magnetic resonance imaging, contrast-enhanced mammography, and molecular breast imaging, can be used in conjunction with screening mammograms to increase the sensitivity of cancer detection.
Purpose of Review
To discuss how advanced breast imaging modalities can supplement standard breast imaging with mammography, ultrasound, and MRI.
Recent Findings
For the last 40–50 years, the primary ...breast cancer screening examination has been mammography which has undergone many changes from xeromammography, film-screen analog, to digital mammography techniques. Digital breast tomosynthesis (DBT) and contrast-enhanced mammography (CEM) are the most recent advances to digital mammography. Molecular breast imaging (MBI) and positron emission mammography (PEM) are nuclear medicine breast examinations that utilize mammographic positioning and are useful supplements to standard breast imaging examination.
Summary
Advances in mammographic techniques have improved the sensitivity and specificity of mammography in detecting breast cancer, demonstrating the extent of disease, and evaluating the response to systemic treatments. Understanding how advanced mammographic techniques fit in with other available breast imaging examinations helps ensure optimal evaluation to help guide treatment decisions.
We trained and validated a deep learning model that can predict the treatment response to neoadjuvant systemic therapy (NAST) for patients with triple negative breast cancer (TNBC). Dynamic contrast ...enhanced (DCE) MRI and diffusion-weighted imaging (DWI) of the pre-treatment (baseline) and after four cycles (C4) of doxorubicin/cyclophosphamide treatment were used as inputs to the model for prediction of pathologic complete response (pCR). Based on the standard pCR definition that includes disease status in either breast or axilla, the model achieved areas under the receiver operating characteristic curves (AUCs) of 0.96 ± 0.05, 0.78 ± 0.09, 0.88 ± 0.02, and 0.76 ± 0.03, for the training, validation, testing, and prospective testing groups, respectively. For the pCR status of breast only, the retrained model achieved prediction AUCs of 0.97 ± 0.04, 0.82 ± 0.10, 0.86 ± 0.03, and 0.83 ± 0.02, for the training, validation, testing, and prospective testing groups, respectively. Thus, the developed deep learning model is highly promising for predicting the treatment response to NAST of TNBC.Clinical Relevance- Deep learning based on serial and multiparametric MRIs can potentially distinguish TNBC patients with pCR from non-pCR at the early stage of neoadjuvant systemic therapy, potentially enabling more personalized treatment of TNBC patients.
Thalidomide analogs exert their therapeutic effects by binding to the CRL4
E3 ubiquitin ligase, promoting ubiquitination and subsequent proteasomal degradation of specific protein substrates. ...Drug-induced degradation of IKZF1 and IKZF3 in B-cell malignancies demonstrates the clinical utility of targeting disease-relevant transcription factors for degradation. Here, we found that avadomide (CC-122) induces CRBN-dependent ubiquitination and proteasomal degradation of ZMYM2 (ZNF198), a transcription factor involved in balanced chromosomal rearrangements with
and
in aggressive forms of hematologic malignancies. The minimal drug-responsive element of ZMYM2 is a zinc-chelating MYM domain and is contained in the N-terminal portion of ZMYM2 that is universally included in the derived fusion proteins. We demonstrate that avadomide has the ability to induce proteasomal degradation of ZMYM2-FGFR1 and ZMYM2-FLT3 chimeric oncoproteins, both
and
. Our findings suggest that patients with hematologic malignancies harboring these
fusion proteins may benefit from avadomide treatment.
Approximately one-third of all cervical spine injuries involve the craniocervical junction (CCJ). Composed of the occiput and the first two cervical vertebrae, this important anatomic landmark, in ...conjunction with an intricate ligamentous complex, is essential to maintaining the stability of the cervical spine. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department. Understanding the anatomy of the CCJ is crucial in properly evaluating the cervical spine, allowing the radiologist to assess its stability in the trauma setting. The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlantoaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management. Thin-section multidetector computed tomography with sagittal and coronal reformats is the study of choice in evaluating the extent of injury, allowing the radiologist to thoroughly evaluate the stability of the cervical spine. Furthermore, magnetic resonance (MR) imaging is increasingly being used to evaluate the spinal soft tissues and ligaments, and to identify associated spinal cord injury, if present. MR imaging is also indicated in patients whose neurologic status cannot be evaluated within 48 hours of injury. .
Background
There are two fundamental approaches to clinical reasoning, intuitive and analytical. These approaches have yet to be well explored to describe how pharmacists make decisions to determine ...medication appropriateness.
Objective
(1) to identify the cognitive actions (i.e., operators) that pharmacists employ when they move from one cue (i.e., concept) to another, and (2) to describe the overall clinical reasoning approach taken by pharmacists when checking for medication appropriateness.
Setting
Pharmacists from a chain pharmacy in Canada were invited to participate in this study.
Method
Data was collected in private rooms using video recordings to capture simulated patient–pharmacist interactions of a new prescription medication. A simulated case scenario was used to gather two types of verbal reports, concurrent think-aloud and structured retrospective think-aloud from pharmacists. All verbal reports were video-recorded, transcribed verbatim, and analyzed using protocol analysis.
Main outcome measure
Pharmacists’ reasoning approaches when making medication appropriateness decisions.
Results
A total of 17 pharmacists participated. Pharmacists were most likely to use analytical clinical reasoning approaches when checking prescriptions and three used no clinical reasoning. When the pharmacists were asked specific questions regarding the decision-making model for pharmacy (i.e., check for indication, efficacy, safety, and adherence), 50% reported using analytical decision-making approaches, with a third of the decisions being made in hindsight.
Conclusion
The majority of the pharmacists followed an analytical decision-making approach to clinical reasoning. When the pharmacists were asked prompting questions about their medication-related decisions, they employed a combination of intuitive and analytical approaches. The pharmacists had the competency to check for medication appropriateness; though this knowledge was mostly restructured during the process of hindsight reasoning.
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