The TNM staging system for cancer was developed by Pierre Denoix in France in the 1940s and 1950s. The North American effort to standardize the TNM system for cancer staging was first organized in 1959 as the American Joint Committee for Cancer Staging and End-Results Reporting, which is now the American Joint Committee on Cancer (AJCC). The most recent edition of the AJCC Cancer Staging Manual, the eighth edition, was globally adopted on January 1, 2018. Previous editions of the manual have relied on anatomic methods of staging alone, which used population-based survival data to predict clinical outcomes. In the era of precision medicine, the major change in the eighth edition is the incorporation of prognostic biomarkers to more accurately predict clinical outcomes and treatment response on an individual basis, without relying solely on the anatomic extent of disease. Factors such as tumor grade, hormone receptor and oncogene expression, and multigene panel recurrence scores are now integrated with anatomic information to yield a final prognostic stage group, which will provide better stratification of patient prognosis. The purpose of this article is to review the major changes in the AJCC eighth edition for breast cancer staging, review anatomic TNM staging, familiarize the radiologist with prognostic biomarkers and prognostic staging, and identify key sites of disease that may alter clinical management. ©

Although numerous studies have outlined the benefits of contrast material-enhanced magnetic resonance (MR) imaging for the detection of breast parenchymal findings, the assessment of lesions of the skin and superficial tissue at breast MR imaging has largely been overlooked. Such lesions, both benign and malignant, are commonly encountered at breast MR imaging, and their detection and diagnosis are often imperative. These lesions include superficial, locally extensive, inflammatory, and recurrent breast cancers; iatrogenic changes; sebaceous cysts; and less prevalent diseases such as granulomatous mastitis and angiosarcomas, among others. As MR imaging continues to be used with increasing frequency in both the screening and diagnostic settings, these lesions will be encountered more often; consequently, a better understanding of which lesions may be ignored and which require further evaluation will become increasingly important. Frequently, MR imaging alone may not clearly indicate the cause of lesions of the breast skin and superficial tissue. However, radiologists should thoroughly assess such lesions, taking into consideration the spectrum of possible causes. Mammography, ultrasonography, consultation with clinicians or dermatologists regarding physical examination findings, and, when necessary, correlation with pathologic findings in biopsy specimens may be used in conjunction with MR imaging to establish both the importance of these lesions and their definitive diagnoses.

Rationale and Objectives We present an optical mammography study that aims to develop quantitative measures of pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Such quantitative measures are based on the concentrations of oxy-hemoglobin ([HbO2]), deoxy-hemoglobin ([Hb]), total hemoglobin ([HbT]), and hemoglobin saturation (SO2) in breast tissue at the tumor location and at sequential time-points during chemotherapy. Materials and Methods Continuous-wave, spectrally resolved optical mammography was performed in transmission and parallel-plate geometry on ten patients prior to treatment initiation and at each NAC administration (mean number of optical mammography sessions: 12; range: 7–18). Data on two patients were discarded for technical reasons. Patients were categorized as responders (>50% decrease in tumor size), or non-responders (<50% decrease in tumor size) based on imaging and histopathology results. Results At 50% completion of the NAC regimen (therapy midpoint), responders (6/8) demonstrated significant decreases in SO2 (−27% ± 4%) and [HbT] (−35 ± 4 µM) at the tumor location with respect to baseline values. By contrast, non-responders (2/8) showed non-significant changes in SO2 and [HbT] at therapy midpoint. We introduce a cumulative response index (CRI) as a quantitative measure of the individual patient’s response to therapy. At therapy midpoint, the SO2-based CRI had a sensitivity of 100% and a specificity of 100% for the identification of responders. Conclusion These results show that optical mammography is a promising tool to assess individual response to NAC at therapy midpoint to guide further decision making for neoadjuvant therapy.

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Abstract. We present a study of the bilateral symmetry of human breast hemoglobin saturation maps measured with a broadband optical mammography instrument. We have imaged 21 patients with unilateral breast cancer, 32 patients with unilateral benign lesions, and 27 healthy patients. An image registration process was applied to the bilateral hemoglobin saturation (SO 2 ) images by assigning each pixel to the low, middle, or high range of SO 2 values, where the thresholds for the categories were the 15th and 85th percentiles of the individual saturation range. The Dice coefficient, which is a measure of similarity, was calculated for each patient's pair of right and left breast SO 2 images. The invasive cancer patients were found to have an average Dice coefficient value of 0.55 AE 0.07, which was significantly lower than the benign and healthy groups (0.61 AE 0.11 and 0.62 AE 0.12, respectively). Although differences were seen in a group analysis, the healthy patient Dice coefficients spanned a wide range, limiting the diagnostic capabilities of this SO 2 symmetry analysis on an individual basis. Our results suggest that for assessing the SO 2 contrast of breast lesions, it may be better to select a reference tissue in the ipsilateral rather than the contralateral breast. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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