Unenhanced CT plus MR imaging was more accurate for distinguishing TDLs from glioma or CNS lymphoma than contrast-enhanced MR imaging alone.

Purpose: To investigate whether a correlation exists between perfusion parameters obtained from dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and prognostic factors or immunohistochemical subtypes of breast cancers. Materials and Methods:Quantitative parameters (K trans , k ep , and v e ) of 70 invasive ductal carcinomas were obtained using DCE-MRI as a postprocessing procedure. Correlations between parameters and prognostic factors, including tumor size, axillary nodal status, histologic grade, nuclear grade, expression of estrogen receptor (ER), progesterone receptor (PR), Ki-67, p53, bcl-2, and human epidermal growth factor receptor 2 (HER2) and subtypes categorized as luminal (ER or PR-positive), triple negative (ER or PR-negative, HER2-negative), and HER2 (ER and PR-negative, HER2 overexpression) were analyzed.Results: Mean K trans was higher in tumors with a high histologic grade than with a low histologic grade (P ¼ 0.007), with a high nuclear grade than with a low nuclear grade (P ¼ 0.002), and with ER negativity than ER positivity (P ¼ 0.056). Mean k ep was higher in tumors with a high histologic grade than with a low histologic grade (P ¼ 0.005), with a high nuclear grade than with a low nuclear grade (P ¼ 0.001), and with ER negativity than with ER positivity (P ¼ 0.043). Mean v e was lower in tumors with a high histologic grade than with a low histologic grade (P ¼ 0.038) and with ER negativity than with ER positivity (P ¼ 0.015). Triple-negative cancers showed a higher mean k ep than the luminal type (P ¼ 0.015).Conclusion: Breast cancers with higher K trans and k ep , or lower v e , had poor prognostic factors and were often of the triple-negative subtype. IN THE PAST DECADE, the role of dynamic contrastenhanced (DCE) breast magnetic resonance imaging (MRI) has expanded beyond the differentiation of benign from malignant masses, preoperative evaluation, and breast cancer screening to an early prediction of the response to neoadjuvant chemotherapy (1,2). There has been an emerging interest in the development of MRI-based biomarkers of the microvascular structure of breast cancers to predict the prognosis and therapeutic response to antiangiogenic treatment. Recently, peripheral rim enhancement on MRI was correlated with a high histologic grade, a negative expression of estrogen receptor, or a high expression of . However, controversy regarding the existence of a correlation between the kinetic parameters on DCE-MRI and prognostic factors remains. A small number of studies have reported no correlation between the enhancement ratio or time-signal intensity curve types and prognostic factors (7,8). Another study reported that the washout curve type was an independent predictor of positive Ki-67 expression (6). These studies have mainly reported the correlation between semiquantitative parameters including kinetic curve type and prognostic factors. They did not focus on the correlation between K trans (vascular permeability), k ep (the rate constant of contrast agent escape from the e...

To evaluate the value of the computer-aided diagnosis (CAD) program applied to diagnostic breast ultrasonography (US) based on operator experience.US images of 100 breast masses from 91 women over 2 months (from May to June 2015) were collected and retrospectively analyzed. Three less experienced and 2 experienced breast imaging radiologists analyzed the US features of the breast masses without and with CAD according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and categories. We then compared the diagnostic performance between the experienced and less experienced radiologists and analyzed the interobserver agreement among the radiologists.Of the 100 breast masses, 41 (41%) were malignant and 59 (59%) were benign. Compared with the experienced radiologists, the less experienced radiologists had significantly improved negative predictive value (86.7%–94.7% vs 53.3%–76.2%, respectively) and area under receiver operating characteristics curve (0.823–0.839 vs 0.623–0.759, respectively) with CAD assistance (all P < .05). In contrast, experienced radiologists had significantly improved specificity (52.5% and 54.2% vs 66.1% and 66.1%) and positive predictive value (55.6% and 58.5% vs 64.9% and 64.9%, respectively) with CAD assistance (all P < .05). Interobserver variability of US features and final assessment by categories were significantly improved and moderate agreement was seen in the final assessment after CAD combination regardless of the radiologist's experience.CAD is a useful additional diagnostic tool for breast US in all radiologists, with benefits differing depending on the radiologist's level of experience. In this study, CAD improved the interobserver agreement and showed acceptable agreement in the characterization of breast masses.

Most breast cancers (81%) detected at screening US were not seen at mammography, even in retrospect. In addition, 19% had subtle or evident findings missed at mammography.

• Sonoelastography has higher specificity than B-mode ultrasound in distinguishing benign from malignant masses. • Sonoelastography could potentially help reduce the number of biopsies with benign results. • Lesion stiffness on sonoelastography correlated with the malignant potential of the lesion.

The presence and severity of BAC and LBM were significantly associated with the risk of subclinical CAD in asymptomatic women. BAC evaluation especially provides an independent and incremental value over conventional risk algorithms. (Women Health Cohort for Breast, Bone and Coronary Artery Disease [BBC]; NCT03235622.).

PurposeThe management of benign intraductal papilloma (IDP) without atypia diagnosed on core needle biopsy (CNB) remains controversial. This study was performed to evaluate the rate of upgrading to malignancy or high-risk lesions after excision and to identify factors associated with upgrading using a large series of benign IDP cases without atypia.MethodsWe included patients who were diagnosed as having benign IDP without atypia on CNB and underwent surgical or vacuum-assisted excision between 2010 and 2015. We analyzed the clinical, radiologic, and histopathologic features of IDPs that were upgraded to malignancy or high-risk lesions after excision.ResultsA total of 511 benign IDPs without atypia diagnosed via CNB were identified, of which 398 cases were treated with excision. After reviewing these cases, four cases of high-risk lesions in adjacent tissue on CNB, two cases which were revealed as papilloma with atypia, and nine cases of malignancy in the same breast were excluded. In the remaining 383 cases, the rate of upgrading to malignancy and high-risk lesions after excision was 0.8% and 4.4%, respectively. The presence of concurrent contralateral breast cancer, the presence of symptoms, and multifocality were factors significantly associated with upgrading to malignancy on subsequent excision. Surgical excision rather than vacuum-assisted excision was significantly associated with upgrading to high-risk lesions or malignancy.ConclusionThe rate of upgrading to malignancy for benign IDP without atypia was very low, suggesting that close clinical and radiologic observation may be sufficient for patients with benign IDP without atypia on CNB under proper settings.

Background The change in apparent diffusion coefficient (ADC) measured from diffusion‐weighted imaging (DWI) has been shown to be predictive of pathologic complete response (pCR) for patients with locally invasive breast cancer undergoing neoadjuvant chemotherapy. Purpose To investigate the additive value of tumor ADC in a multicenter clinical trial setting. Study Type Retrospective analysis of multicenter prospective data. Population In all, 415 patients who enrolled in the I‐SPY 2 TRIAL from 2010 to 2014 were included. Field Strength/Sequence 1.5T or 3T MRI system using a fat‐suppressed single‐shot echo planar imaging sequence with b‐values of 0 and 800 s/mm2 for DWI, followed by a T1‐weighted sequence for dynamic contrast‐enhanced MRI (DCE‐MRI) performed at pre‐NAC (T0), after 3 weeks of NAC (T1), mid‐NAC (T2), and post‐NAC (T3). Assessment Functional tumor volume and tumor ADC were measured at each MRI exam; pCR measured at surgery was assessed as the binary outcome. Breast cancer subtype was defined by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. Statistical Tests A logistic regression model was used to evaluate associations between MRI predictors with pCR. The cross‐validated area under the curve (AUC) was calculated to assess the predictive performance of the model with and without ADC. Results In all, 354 patients (128 HR+/HER2–, 60 HR+/HER2+, 34 HR–/HER2+, 132 HR–/HER2–) were included in the analysis. In the full cohort, adding ADC predictors increased the AUC from 0.76 to 0.78 at mid‐NAC and from 0.76 to 0.81 at post‐NAC. In HR/HER2 subtypes, the AUC increased from 0.52 to 0.65 at pre‐NAC for HR+/HER2–, from 0.67 to 0.73 at mid‐NAC and from 0.72 to 0.76 at post‐NAC for HR+/HER2+, from 0.71 to 0.81 at post‐NAC for triple negatives. Data Conclusion The addition of ADC to standard functional tumor volume MRI showed improvement in the prediction of treatment response in HR+ and triple‐negative breast cancer. Level of Evidence: 2 Technical Efficacy Stage: 4 J. Magn. Reson. Imaging 2019;50:1742–1753.