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Rationale and Objectives: To compare the image quality between conventional and synthetic aperture (SA) imaging in breast ultrasound (US). Materials and Methods: Twenty-four patients with 31 breast lesions were included in our study. The US data were processed with SA algorithm. For quantitative analysis, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated. For qualitative analysis, conventional and SA images were reviewed by three radiologists and diagnostic preference (conspicuity, margin sharpness, and contrast) was assessed. The radiologists also determined whether artifacts were present. Parameters were analyzed using a paired t-test, Wilcoxon signed-rank test, and chi-square test. Results: The mean CNRs were higher in SA images compared with conventional images (mean, 2.56 versus 2.28, P = .004). The mean SNRs were higher in SA images compared with conventional images (31.62 versus 25.26, P < .0001). SA images were considered as being "better" or "much better" in 16-23 (51.6-74.2%) lesions of total 31 lesions for conspicuity, in 17-24 (45.2%-77.4%) for margin sharpness, and in 13-23 (41.9%-74.2%) for contrast. Significant preferences in SA images were demonstrated (conspicuity, P < .05 for all radiologists; margin sharpness and contrast in two radiologists). Refraction and speckle artifacts were less frequently observed in SA images (refraction, P < .05 for all radiologists; speckle, P < .05 for two radiologists), whereas reflection artifacts were more frequent in SA images (P < .05 in two radiologists). Conclusion: SA imaging provides better image quality than conventional imaging in patients with focal breast lesions in breast US. [ABSTRACT FROM AUTHOR]

Background: The computer-aided detection (CAD) system is widely used for screening mammography. The performance of the CAD system for contralateral breast cancer has not been reported for women with a history of breast cancer. Purpose: To retrospectively evaluate the performance of a CAD system on current and previous mammograms in patients with contralateral metachronous breast cancer. Material and Methods: During a 3-year period, 4945 postoperative patients had follow-up examinations, from whom we selected 55 women with contralateral breast cancers. Among them, 38 had visible malignant signs on the current mammograms. We analyzed the sensitivity and false-positive marks of the system on the current and previous mammograms according to lesion type and breast density. Results: The total visible lesion components on the current mammograms included 27 masses and 14 calcifications in 38 patients. The case-based sensitivity for all lesion types was 63.2% (24/38) with false-positive marks of 0.71 per patient. The lesion-based sensitivity for masses and calcifications was 59.3% (16/27) and 71.4% (10/14), respectively. The lesion-based sensitivity for masses in fatty and dense breasts was 68.8% (11/16) and 45.5% (5/11), respectively. The lesion-based sensitivity for calcifications in fatty and dense breasts was 100.0% (3/3) and 63.6% (7/11), respectively. The total visible lesion components on the previous mammograms included 13 masses and three calcifications in 16 patients, and the sensitivity for all lesion types was 31.3% (5/16) with false-positive marks of 0.81 per patient. On these mammograms, the sensitivity for masses and calcifications was 30.8% (4/13) and 33.3% (1/3), respectively. The sensitivity in fatty and dense breasts was 28.6% (2/7) and 33.3% (3/9), respectively. Conclusion: In the women with a history of breast cancer, the sensitivity of the CAD system in visible contralateral breast cancer was lower than in most previous reports using the same CAD system probably due to the relatively small size, subtlety of the lesion findings, and dense parenchymal pattern. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic value of sonoelastography by correlation with histopathology compared with conventional ultrasound on the decision to biopsy.Methods: Prospectively determined BI-RADS categories of conventional ultrasound and elasticity scores from strain sonoelastography of 1786 non-palpable breast masses (1,523 benign and 263 malignant) in 1,538 women were correlated with histopathology. The sensitivity and specificity of two imaging techniques were compared regarding the decision to biopsy. We also investigated whether there was a subset of benign masses that were recommended for biopsy by B-mode ultrasound but that had a less than 2% malignancy rate with the addition of sonoelastography.Results: The mean elasticity score of malignant lesions was higher than that of benign lesions (2.94 ± 1.10 vs. 1.78 ± 0.81) (P < 0.001). In the decision to biopsy, B-mode ultrasound had higher sensitivity than sonoelastography (98.5% vs. 93.2%) (P < 0.001), whereas sonoelastography had higher specificity than B-mode ultrasound (42.6% vs. 16.3%) (P < 0.001). BI-RADS category 4a lesions with an elasticity score of 1 had a malignancy rate of 0.8%.Conclusions: Sonoelastography has higher specificity than B-mode ultrasound in the differentiation between benign and malignant masses and has the potential to reduce biopsies with benign results.Key Points: • 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. [ABSTRACT FROM AUTHOR]

Background: Unexpected focal 18F-FDG breast uptakes are occasionally identified on PET/CT due to its increased use for cancer staging and follow-up. The need for their characterization has been suggested. Purpose: To retrospectively evaluate the diagnostic value of ultrasonography (US) in distinguishing benign from malignant lesions for unexpected focal 18F-FDG uptakes in breast on PET/CT scans. Material and Methods: Between April 2004 and January 2010, 27 focal 18F-FDG breast uptakes in 27 patients (age range 33-62 years; mean age 46 years) among 5214 patients who had undergone PET/CT scans were retrospectively analyzed. The American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) final assessment categories of the US and the maximum standardized uptake values (SUVs) of the lesions were compared between the benign and malignant lesions. Results: Of the 27 lesions, 15 (56%) lesions were malignant. The rate of malignancy, according to the final assessment category on the US, was 0% (0 of 6) for category 3, 60% for category 4 (9 of 15), and 100% (6 of 6) for category 5 (P = 0.001). The US evaluation revealed a sensitivity of 100% (15 of 15) and a specificity of 50% (6 of 12). The average maximum SUV of the malignant lesions was greater than that of the benign lesions (4.12 ± 1.94 vs. 1.94 ± 0.82; P = 0.001). Conclusion: US evaluation of unexpected focal 18F-FDG uptakes on PET/CT scans can accurately distinguish benign lesions from malignant lesions. [ABSTRACT FROM AUTHOR]

Objective: To compare the use of diffusion-weighted MR imaging (DWI) and (18)F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy.Methods: Thirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis.Results: After surgery, 7/34 patients (20.6%) were found to have pCR. A( z ) values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI.Conclusions: DWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate whether sonoelastographic evaluation could help predict the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy.Methods: One hundred and three consecutive nonpalpable DCIS lesions diagnosed at US-guided needle biopsy were analyzed. To identify the preoperative factors associated with upgrade to invasive cancers on surgical histology, lesion size, B-mode US findings, elasticity score, biopsy variables, and histological variables were analyzed using univariate and multivariate logistic regression. Interobserver agreement for the elasticity score was evaluated using the multi-rater κ statistics.Results: The overall upgrade rate was 23% (24 of 103). Elasticity score was found to be the only independent predictor of invasion. The upgrade rates according to the median elasticity score was 6.7% (1 of 15) for a score of 1, 20.6% (13 of 63) for a score of 2, and 40.0% (10 of 25) for a score of 3 (Odds ratio [OR] = 1; OR = 4.19, P = 0.207; OR = 12.32, P = 0.039, respectively). No association was found between other factors and the upgrade rate. The overall interobserver agreement for the elasticity score was moderate (κ = 0.587; P < .001).Conclusions: Sonoelastographic lesion stiffness is an independent preoperative predictor of invasion in some patients with nonpalpable DCIS at US-guided needle biopsy. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate the detection performance of benign and malignant breast masses using 3D volume data obtained by ABUS and to determine lesion variables which affect detectability. Methods: Between November and December of 2007, bilateral whole breast US images were obtained using ABUS in 67 consecutive women who were scheduled to undergo US-guided needle biopsy due to suspicious breast masses. Twenty-four invasive ductal cancers in 23 breasts, 46 benign breast lesions in 44 breasts and 38 normal breasts were included. Three breast radiologists (experience range, 8-16 years) who did not perform the examinations and were blinded to the histology independently reviewed the ABUS data of the 105 breasts to detect suspicious solid masses with pathology as the standard of reference. Sensitivity and specificity in detecting benign and malignant masses were calculated, and lesion characteristics affecting detectability were analyzed. Results: Sensitivities for benign and malignant mass detections were 65.2% (30/46), 95.8% (23/24) for reader 1 (p=0.007), 66.7% (31/46), 87.5% (21/24) for reader 2 (p=0.087), and 56.3% (24/46), 91.7% (22/24), for reader 3 (p=0.001), respectively. Logistic analysis showed that mass size (odds ratio, 95% CI; 1.12, 1.02-1.24), surrounding tissue changes (odds ratio, 95% CI; 0.11, 0.02-0.47), and shape of the mass (odds ratio, 95% CI; 3.12, 1.02-9.55) were the variables associated with detectability at ABUS. Conclusion: In reader studies using ABUS data, significantly higher sensitivity was noted for malignant breast masses than for benign masses. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography (US) has been used as an important adjunct to mammography (MG), and automated breast US (ABUS) scanners were originally designed to effectively examine the breast in its entirety. Purpose: To retrospectively assess the performance of radiologists in the detection of breast cancers, initially detected by hand-held ultrasound (HHUS), using 3D breast volume data obtained from a commercial ABUS system. Material and Methods: Bilateral whole breast US was performed using ABUS in 61 consecutive women who were scheduled to undergo US-guided needle biopsy due to suspicious breast masses detected during screening HHUS. Fourteen cancers in 13 women and 48 normal breasts of 48 women with benign disease in the contralateral breast were selected. Three radiologists who had not performed the HHUS examinations independently reviewed the 3D ABUS data for any lesions that required recall for further evaluation. Sensitivities and false-positive rates were calculated. Results: The sensitivities of the three readers for cancer detection were 78.6% (11/14), 78.6%, and 57.1% (8/14), respectively, with false-positive rates of 20.8% (10/48), 12.5% (6/48) and 8.3% (4/48). Seven cancers were detected by all three readers, four cancers by two readers, and one cancer by one reader. Two invasive cancers were not detected by any reader. Conclusion: Of HHUS-detected cancers, only 57.1-78.6% were identified with ABUS. A substantial level of experience and training is necessary to improve cancer detection by ABUS. [ABSTRACT FROM AUTHOR]

Background: It has been reported that ultrasound (US)-elastography is helpful in differentiation of benign and malignant solid masses and in reducing benign biopsy procedures for the supplemental breast US in addition to screening mammography. Furthermore, potential application of US-elastography in distinguishing cystic lesions which is known to be a major source of benign biopsy results has been suggested. Purpose: To describe the aliasing artifact on US-elastography for breast cystic lesions that mimic solid masses. Material and Methods: We retrospectively reviewed 13 lesions which showed a blue-green-red pattern artifact on US-elastography in 13 women (mean age 50 years; age range 3-66 years). They disappeared immediately after a needle biopsy. Breast composition, mammography and US findings, histology and follow-up imaging findings were analyzed. Results: All 13 patients showed heterogeneously dense (n=5) or extremely dense breast parenchyma (n=8). The most common US findings were an irregular shape (n=7, 54%) and a circumscribed margin (n=7, 54%). All 13 lesions had internal echogenicity and were initially considered as solid masses; 62% (n=8) showed hypoechogenicity and 38% (n=5) had echogenic and anechoic components. Posterior shadowing was seen in 31% (n=4) of the lesions. All 13 lesions have been proven to be fibrocystic changes on biopsy histology. Follow-up US performed for 10 of 13 lesions showed no residual lesion (n=9) or decreased its size (n=1). Conclusion: An aliasing artifact that appears as a blue-green-red pattern in a breast mass as depicted on US-elastography is suggestive of a possible cystic breast lesion. [ABSTRACT FROM AUTHOR]

Background: Supplemental screening ultrasonography (US) in addition to mammography can help detect early breast cancers in women with dense breasts and other risk factors. It is crucial to understand the imaging features of US-detected cancer to identify them in screening population. Purpose: To retrospectively evaluate the US features and final assessments of breast cancers detected by supplemental screening US in comparison with cancers seen on screening mammography. Material and Methods: The study included 80 women (mean age 46 years, range 31–65 years) with 80 breast cancers detected by supplemental screening US. Another 80 women (mean age 52 years, range 33–77 years) with 80 breast cancers seen on screening mammography were included for a control group. US features and final assessments were classified according to the Breast Imaging Reporting and Data System (BI-RADS) without knowledge of the method of detection, or mammographic or histologic findings. Results of the two groups were compared. Results: Breast cancers detected by supplemental screening US were more frequently found to have the following features: an oval shape (21% [17/80] vs 10% [8/80], P = 0.013), a circumscribed margin (13% [10/80] vs 4% [3/80], P = 0.043), an abrupt interface (79% [63/80] vs 53% [42/80], P < 0.001), and no posterior acoustic (70% [56/80] vs 53% [42/80], P = 0.023) or surrounding tissue (79% [63/80] vs 28% [22/80], P < 0.001) changes. For the final assessment, 93% (74/80) of US-detected cancers and 60% (48/80) of cancers seen on mammography were classified as a category 4, while 3% (2/80) of US-detected cancers and 38% (30/80) of cancers seen on mammography were category 5. Conclusion: Compared with breast cancers seen on screening mammography, breast cancers detected by supplemental screening US tend to have less malignant US features, although most (95%) of them were classified as category 4 or 5. [ABSTRACT FROM AUTHOR]

Objective: To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS).Methods: We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated.Results: In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls.Conclusions: Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients. [ABSTRACT FROM AUTHOR]

Objective: To prospectively determine the upgrade rate following surgery in benign papilloma initially diagnosed at ultrasound (US)-guided 14-gauge gun biopsy.Methods: A total of 128 benign papillomas were diagnosed in 114 patients after a US-guided biopsy. Surgical excision was recommended where the biopsy indicated benign papilloma, regardless of imaging findings. The upgrade rate to 'atypical' and 'malignancy' was measured on a per-lesion basis. We analysed potential associations between clinical presentation, lesion variables and the results of surgical excision (using logistic regression).Results: Of the 114 patients, 87 eventually underwent surgery: among the 100 supposed benign papillomas, surgical excision revealed fibrocystic change or no residual lesion in nine cases, intraductal papilloma in 74, atypical papilloma in 13, papillary ductal carcinoma in situ (DCIS) in three and one invasive papillary carcinoma. The upgrade rate for an atypical papilloma or papilloma with adjacent foci of atypical ductal hyperplasia (ADH) and malignancy was 13% (95% CI = 7.1-21.2%) and 4% (95% CI = 1.1-9.9%), respectively. The mean lesion size (P = 0.041) was significantly larger when lesions were upgraded to malignancy. Other features were not significantly associated with pathological underestimation (P > 0.05).Conclusion: Surgical excision should be considered for benign intraductal papillomas above 1.5 cm in size. [ABSTRACT FROM AUTHOR]

BACKGROUND: A higher prevalence of chronic kidney disease (CKD) has been found in genetic relatives of patients with end-stage renal disease. However, the risk of CKD in nongenetic spouses of patients with end-stage renal disease is still unknown. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 196 first- and second-degree relatives and 95 spouses of 178 hemodialysis (HD) patients were enrolled. Two sex- and age-stratified matched counterpart controls were randomly selected from the population of a community screening program for CKD. PREDICTORS: Relatives or spouses of HD patients and kidney disease risk factors. OUTCOMES: Prevalence of CKD (albuminuria or low estimated glomerular filtration rate). MEASUREMENT: Albuminuria (urine albumin-creatinine ratio > or = 30 mg/g), low estimated glomerular filtration rate (<60 mL/min/1.73 m(2)), and kidney disease risk factors of age, hypertension, diabetes mellitus, metabolic syndrome, and lifestyle. RESULTS: A significantly higher prevalence of CKD was found in relatives (15.8% vs 7.5%; P = 0.01) and spouses (41.1% vs 15.8%; P < 0.001) of HD patients compared with their counterpart controls. Multiple logistic regression analysis showed that age (OR, 1.05) and hypertension (OR, 3.13) were significant independent risk factors for CKD in relatives of HD patients, whereas diabetes mellitus (OR, 3.51) was a significant risk factor for CKD in spouses of HD patients. For all pooled participants, being relatives (OR, 2.55) or spouses (OR, 2.80) of HD patients, age (OR, 1.06), female sex (OR, 1.81), diabetes mellitus (OR, 3.95), hypertension (OR, 1.85), and hyperuricemia (OR, 2.06) were independent significant risk factors for CKD. LIMITATIONS: Cross-sectional research design, single laboratory measurement, and limited numbers of participants. CONCLUSIONS: A comprehensive screening program for CKD is equally important in both relatives and spouses of HD patients, especially for participants with the renal risk factors of older age, hypertension, and diabetes mellitus. Spousal concordance of CKD suggests that the shared environmental factors and health behaviors might have important roles in the development of CKD. [ABSTRACT FROM AUTHOR]

Background: The performance of the computer-aided detection (CAD) system can be determined by the sensitivity and false-positive marks rate, therefore these factors should be improved by upgrading the software version of the CAD system. Purpose: To compare retrospectively the performances of two software versions of a commercially available CAD system when applied to full-field digital mammograms for the detection of breast cancers in a screening group. Material and Methods: Versions 3.1 and 8.3 of a CAD software system (ImageChecker, R2 Technology) were applied to the full-field digital mammograms of 130 women (age range 36-80, mean age 53 years) with 130 breast cancers detected by screening. Results: The overall sensitivities of the version 3.1 and 8.3 CAD systems were 92.3% (120 of 130) and 96.2% (125 of 130) (P=0.025), respectively, and sensitivities for masses were 78.3% (36 of 46) and 89.1% (41 of 46) (P=0.024) and for microcalcifications 100% (84 of 84) and 100% (84 of 84), respectively. Version 8.3 correctly marked five lesions of invasive ductal carcinoma that were missed by version 3.1. Average numbers of false-positive marks per image were 0.38 (0.15 for calcifications, 0.23 for masses) for version 3.1 and 0.46 (0.13 for calcifications, 0.33 for masses) for version 8.3 (P=0.1420). Conclusion: The newer version 8.3 of the CAD system showed better overall sensitivity for the detection of breast cancer than version 3.1 due to its improved sensitivity for masses when applied to full-field digital mammograms. [ABSTRACT FROM AUTHOR]

Background: Microcalcifications found on mammography of asymptomatic women can be sampled by ultrasound (US)-guided percutaneous breast biopsy when stereotactic core biopsy is unavailable or unsuccessful. The role of specimen radiograph needs to be reevaluated after US-guided biopsy. Purpose: To compare retrospectively the histological diagnoses of calcified cores and non-calcified cores as depicted on specimen radiographs after a US-guided, 11-gauge, vacuum-assisted biopsy using surgical histology as the reference standard. Material and Methods: A total of 135 consecutive patients underwent a US-guided vacuum-assisted biopsy for calcifications with malignant histological results from 135 lesions. For each lesion, calcification was identified in at least one core on specimen radiographs. Calcified cores and non-calcified cores depicted on specimen radiographs were separately submitted to the pathology department. The pathological diagnoses of calcified cores and non-calcified cores were compared with final diagnoses at surgical excision. Results: Of a total of 2049 core specimens that were obtained (mean, 15 per lesion; range, 4-35 per lesion), 794 cores (mean, 5.9 per lesion; range, 1-17 per lesion) contained calcifications and 1255 cores (mean, 9.3 cores per lesion; range, 1-34 cores per lesion) did not contain calcifications. Calcified cores were more likely to enable an accurate diagnosis of cancer as compared to non-calcified cores (67%, 91 of 135 versus 52%, 70 of 135; P = 0.009). A diagnosis of cancer was more likely to be missed with non-calcified cores as compared to calcified cores (16%, 21 of 135 versus 4%, 5 of 135; P = 0.002). There was no difference in the underestimation of malignancy between calcified cores (29%, 39 of 135) and non-calcified cores (33%, 44 of 135) (P = 0.510). Conclusion: Calcified cores depicted on specimen radiographs are more accurate for a diagnosis of cancer as compared to non-calcified cores obtained during US-guided vacuum-assisted biopsy of microcalcifications. [ABSTRACT FROM AUTHOR]

Background: There are relatively few studies reporting the frequency of false-positive computer-aided detection (CAD) marks and their reproducibility in normal cases. Purpose: To evaluate retrospectively the false-positive mark rate of a CAD system and the reproducibility of false-positive marks in two sets of negative digital mammograms. Material and Methods: Two sets of negative digital mammograms were obtained in 360 women (mean age 57 years, range 30-76 years) with an approximate interval of 1 year (mean time 343.7 days), and a CAD system was applied. False-positive CAD marks and the reproducibility were determined. Results: Of the 360 patients, 252 (70.0%) and 240 (66.7%) patients had 1-7 CAD marks on the initial and second mammograms, respectively. The false-positive CAD mark rate was 1.5 (1.1 for masses and 0.4 for calcifications) and 1.4 (1.0 for masses and 0.4 for calcifications) per examination in the initial and second mammograms, respectively. The reproducibility of the false-positive CAD marks was 12.0% for both mass (81/680) and microcalcification (33/278) marks. Conclusion: False-positive CAD marks were seen in approximately 70% of normal cases. However, the reproducibility was very low. Radiologists must be familiar with the findings of false-positive CAD marks, since they are very common and can increase the recall rate in screening. [ABSTRACT FROM AUTHOR]

Background: Surgical axillary staging of the axilla is a topic of debate regarding the potential of de-escalation in clinically node negative (cN0) early breast cancer patients treated with breast-conserving therapy. Axillary ultrasound is important to determine clinical nodal status. The aim of the current narrative review is to provide an overview of prospective trials on de-escalating axillary surgical staging in cN0 early breast cancer patients, with an emphasis on axillary ultrasound protocols., Methods: This narrative review provides an overview of the prospective de-escalating axillary surgical staging trials, in terms of comparing sentinel lymph node biopsy (SLNB) versus complete omission of SLNB, in cT1/2N0 patients treated with breast-conserving therapy. Information from each trial was collected, including reported axillary ultrasound protocols (including cortical thickness cut-off value) and axillary ultrasound-guided biopsy technique (fine-needle aspiration or core-needle biopsy)., Results: There is one recently published prospective trial and three ongoing prospective trials within the topic of this narrative review. Number of included patients in these trials ranges from 1405 to 5505 patients. The included trials differed whether or not to include patients with suspicious axillary ultrasound findings and a negative ultrasound-guided biopsy. Cortical thickness cut-off value ranged from 2.3 mm to 3.0 mm. Different ultrasound-guided biopsy techniques were performed among the included trials., Conclusion: Prospective de-escalating axillary surgical staging trials in clinically node negative early breast cancer patients treated with breast-conserving therapy do report differences in terms of axillary ultrasound protocols and ultrasound-guided biopsy techniques. Axillary ultrasound protocols do require uniformity in order to improve extrapolation of these trial results., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Breast density is an independent risk factor for breast cancer, although variability exists in measurements. This study sought to evaluate the agreement between radiologists and automated breast density assessment software and assess the impact of breast density measures on breast cancer risk estimates using the Breast Cancer Surveillance Consortium (BCSC) model (v.2). A retrospective database search identified women who had undergone mammography between December 2021 and June 2022. The Breast Imaging Reporting and Data System (BI-RADS) breast composition index assigned by a radiologist (R) was recorded and analyzed using three commercially available software programs (S1, S2, and S3). The agreement rate and Cohen's kappa (κ) were used to evaluate inter-rater agreements concerning breast density measures. The 5-year risk of invasive breast cancer in women was calculated using the BCSC model (v.2) with breast density inputs from various density estimation methods. Absolute differences in risk between various density measurements were evaluated. Overall, 1,949 women (mean age, 53.2 years) were included. The inter-rater agreement between R, S1, and S2 was 75.0-75.6%, while that between S3 and the others was 60.2%-63.3%. Kappa was substantial between R, S1, and S2 (0.66-0.68), and moderate (0.49-0.50) between S3 and the others. S3 placed fewer women in mammographic density d (14.9%) than R, S1, and S2 (40.5%-44.0%). In BCSC risk assessment (v.2), S3 assessed fewer women with a high 5-year risk of invasive breast cancer than the other methods, resulting in an absolute difference of 0% between R, S1, and S2 in 75.0%-75.6% of cases, whereas the difference between S3 and the other methods occurs in 60.2%-63.3% of cases. Breast density assessment using various methods showed moderate-to-substantial agreement, potentially affecting risk assessments. Precise and consistent breast density measurements may lead to personalized and effective strategies for breast cancer prevention., Competing Interests: The authors declare that they have no competing interests., (© 2024 Korean Breast Cancer Society.)

Lung cancer remains a formidable health challenge due to its high mortality and morbidity rates. Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancer cases, with small cell lung cancer (SCLC) accounting for the remainder. Both NSCLC and SCLC cells express receptor tyrosine kinases, which may be overexpressed or mutated in lung cancer, leading to increased activation. The c-Met receptor tyrosine kinase, crucial for cell transformation and tumor growth, invasion, and metastasis, became the focus of our study. We used an E1B55KD-deleted, replication-selective oncolytic adenovirus (Ad.What), driven by the c-Met promoter, targeting lung cancer cells with c-Met overexpression, thus sparing normal cells. Previous studies have shown the enhanced antitumor efficacy of oncolytic adenoviruses when combined with chemotherapeutic agents. We explored combining rapamycin, a selective mTOR inhibitor with promising clinical trial outcomes for various cancers, with Ad.What. This combination increased infectivity by augmenting the expression of coxsackievirus and adenovirus receptors and αV integrin on cancer cells and induced autophagy. Our findings suggest that combining a c-Met promoter-driven oncolytic adenovirus with rapamycin could be an effective lung cancer treatment strategy, offering a targeted approach to exploit lung cancer cells' vulnerabilities, potentially marking a significant advancement in managing this deadly disease.

Considerations for the modification of agricultural practices and waste management to improve environmental sustainability remain a subject of great importance. Prioritization of intensive mass food production to meet the demand of an increasing human population has introduced a multitude of environmental issues due to, among other factors, the large volumes of waste output. Tomato production in greenhouses, for example, generates tonnes of bio-waste per hectare each harvest including green tomato plant residues (i.e., stems, leaves, branches). Giving value to these green tomato plant residues collected during the growing cycle and after harvest has not proven straightforward despite a massive yearly release of tonnes of carbon dioxide from stems and leaves disposed on landfills. This paper aims to summarize current research in tomato plant residue valorization and to identify considerations for future valorization strategies. Peer reviewed articles, scientific books and governmental, economic and statistical reports on the topic of tomato plant residues were collected and analyzed. Focuses included traditional valorization approaches, bio-refinement strategies and conversion of fiber-rich residues into high value packaging materials. Initiatives for sustainable agriculture, their market relevance, and the strengths and weaknesses of using tomato plant residues in these valorization approaches are discussed. Overall, it was concluded that valorization of tomato plant residues would be a highly integrative endeavor that would require coordination from multiple levels in the agricultural production chain., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

During COVID-19 pandemic, cases of postvaccination infections and restored SARS-CoV-2 virus have increased after full vaccination, which might be contributed to by immune surveillance escape or virus rebound. Here, artificial linear 9-mer human leucocyte antigen (HLA)-restricted UC peptides were designed based on the well-conserved S2 region of the SARS-CoV-2 spike protein regardless of rapid mutation and glycosylation hindrance. The UC peptides were characterized for its effect on immune molecules and cells by HLA-tetramer refolding assay for HLA-binding ability, by HLA-tetramer specific T cell assay for engaged cytotoxic T lymphocytes (CTLs) involvement, by HLA-dextramer T cell assay for B cell activation, by intracellular cytokine release assay for polarization of immune response, Th1 or Th2. The specific lysis activity assay of T cells was performed for direct activation of cytotoxic T lymphocytes by UC peptides. Mice were immunized for immunogenicity of UC peptides in vivo and immunized sera was assay for complement cytotoxicity assay. Results appeared that through the engagement of UC peptides and immune molecules, HLA-I and II, that CTLs elicited cytotoxic activity by recognizing SARS-CoV-2 spike-bearing cells and preferably secreting Th1 cytokines. The UC peptides also showed immunogenicity and generated a specific antibody in mice by both intramuscular injection and oral delivery without adjuvant formulation. In conclusion, a T-cell vaccine could provide long-lasting protection against SARS-CoV-2 either during reinfection or during SARS-CoV-2 rebound. Due to its ability to eradicate SARS-CoV-2 virus-infected cells, a COVID-19 T-cell vaccine might provide a solution to lower COVID-19 severity and long COVID-19., (© 2024. The Author(s).)

Objective: To identify well-being threats for surgeons and anesthesiologists and develop interventions using the quality of life improvement (QOLI) approach., Background: Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs., Methods: Anesthesia and surgery faculty in 8 perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live voting to identify well-being priorities., Results: One hundred four perioperative faculty completed the survey. Across specialties, higher Mental Health Continuum-Short Form scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded 5 areas for intervention: (1) work culture, (2) work environment/resources, (3) sources of fulfillment, (4) work/life harmony, and (5) financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were operating room inefficiencies/delays and excessive workload, whereas anesthesiologists cited understaffing and unpredictable work hours., Conclusions: Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Chronic kidney disease is related to neurodegeneration and structural changes in the brain which might lead to cognitive decline. The Fazekas scale used for assessing white matter hyperintensities (WMHs) was associated with poor cognitive performance. Therefore, this study investigated the associations between the mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), and Fazekas scale in patients under hemodialysis (HD)., Methods: The periventricular (PV) WMHs and deep WMHs (DWMHs) in brain magnetic resonance images of 59 patients under dialysis were graded using the Fazekas scale. Three cognition function tests were also performed, then multivariable ordinal regression and logistic regression were used to identify the associations between cognitive performance and the Fazekas scale., Results: There were inverse associations between the three cognitive function tests across the Fazekas scale of PVWMHs ( p  = .037, .006, and .008 for MMSE, MoCA, and CASI, respectively), but the associations were attenuated in the DWMHs group. In CASI, significant differences were identified in short-term memory, mental manipulation, abstract thinking, language, spatial construction, and name fluency in the PVWMHs group. However, DWMHs were only significantly correlated with abstract thinking and short-term memory., Conclusion: An inverse correlation existed between the Fazekas scale, predominantly in PVWMHs, and cognition in patients undergoing HD. The PVWMHs were associated with cognitive performance assessed by MMSE, MoCA, and CASI, as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.

Competing Interests: Conflicts of interest and sources of funding: none declared.

Context: Type 2 diabetes (T2D) is the major contributor to chronic kidney disease and end-stage kidney disease (ESKD). The influence of trimethylamine N-oxide (TMAO) on kidney outcomes in T2D remains unclear., Objective: To examine the association between fasting serum TMAO levels and adverse kidney outcomes in patients with T2D., Methods: Between October 2016 and June 2020, patients with T2D were recruited and monitored every 3 months until December 2021. Serum TMAO levels were assessed using liquid chromatography-mass spectrometry. The primary kidney outcomes were doubling of serum creatinine levels or progression to ESKD necessitating dialysis; the secondary kidney outcome was a rapid 30% decline in estimated glomerular filtration rate within 2 years. All-cause mortality was also evaluated., Results: Among the 440 enrolled patients with T2D, those in the highest serum TMAO tertile (≥0.88 μM) were older, had a longer diabetes duration, elevated blood urea nitrogen, and lower estimated glomerular filtration rate. Over a median follow-up period of 4 years, 26 patients (5.9%) had a doubling of serum creatinine level or progression to ESKD. After propensity score weighting, the patients in the highest serum TMAO tertile had a 6.45-fold increase in the risk of doubling of serum creatinine levels or progression to ESKD and 5.86-fold elevated risk of rapid decline in kidney function compared with those in the lowest tertile. Additionally, the stepwise increase in serum TMAO was associated with all-cause mortality., Conclusion: Patients with T2D with elevated circulating TMAO levels are at higher risk of doubling serum creatinine, progressing to ESKD, and mortality. TMAO is a potential biomarker for kidney function progression and mortality in patients with T2D., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background Comparative performance between artificial intelligence (AI) and breast US for women with dense breasts undergoing screening mammography remains unclear. Purpose To compare the performance of mammography alone, mammography with AI, and mammography plus supplemental US for screening women with dense breasts, and to investigate the characteristics of the detected cancers. Materials and Methods A retrospective database search identified consecutive asymptomatic women (≥40 years of age) with dense breasts who underwent mammography plus supplemental whole-breast handheld US from January 2017 to December 2018 at a primary health care center. Sequential reading for mammography alone and mammography with the aid of an AI system was conducted by five breast radiologists, and their recall decisions were recorded. Results of the combined mammography and US examinations were collected from the database. A dedicated breast radiologist reviewed marks for mammography alone or with AI to confirm lesion identification. The reference standard was histologic examination and 1-year follow-up data. The cancer detection rate (CDR) per 1000 screening examinations, sensitivity, specificity, and abnormal interpretation rate (AIR) of mammography alone, mammography with AI, and mammography plus US were compared. Results Among 5707 asymptomatic women (mean age, 52.4 years ± 7.9 [SD]), 33 (0.6%) had cancer (median lesion size, 0.7 cm). Mammography with AI had a higher specificity (95.3% [95% CI: 94.7, 95.8], P = .003) and lower AIR (5.0% [95% CI: 4.5, 5.6], P = .004) than mammography alone (94.3% [95% CI: 93.6, 94.8] and 6.0% [95% CI: 5.4, 6.7], respectively). Mammography plus US had a higher CDR (5.6 vs 3.5 per 1000 examinations, P = .002) and sensitivity (97.0% vs 60.6%, P = .002) but lower specificity (77.6% vs 95.3%, P < .001) and higher AIR (22.9% vs 5.0%, P < .001) than mammography with AI. Supplemental US alone helped detect 12 cancers, mostly stage 0 and I (92%, 11 of 12). Conclusion Although AI improved the specificity of mammography interpretation, mammography plus supplemental US helped detect more node-negative early breast cancers that were undetected using mammography with AI. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Whitman and Destounis in this issue.

The incidence and prevalence of dialysis in Taiwan are high compared to other regions. Consequently, mitigating chronic kidney disease (CKD) and the worsening of kidney function have emerged as critical healthcare priorities in Taiwan. Heat stress is known to be a significant risk factor for CKD and kidney function impairment. However, differences in the impact of heat stress between males and females remains unexplored. We conducted this retrospective cross-sectional analysis using data from the Taiwan Biobank (TWB), incorporating records of the wet bulb globe temperature (WBGT) during midday (11 AM-2 PM) and working hours (8 AM-5 PM) periods based on the participants' residential address. Average 1-, 3-, and 5-year WBGT values prior to the survey year were calculated and analyzed using a geospatial artificial intelligence-based ensemble mixed spatial model, covering the period from 2010 to 2020. A total of 114,483 participants from the TWB were included in this study, of whom 35.9% were male and 1053 had impaired kidney function (defined as estimated glomerular filtration rate < 60 ml/min/1.73 m 2 ). Multivariable analysis revealed that in the male participants, during the midday period, the 1-, 3-, and 5-year average WBGT values per 1 ℃ increase were significantly positively associated with eGFR < 60 ml/min/1.73 m 2 (odds ratio [OR], 1.096, 95% confidence interval [CI] = 1.002-1.199, p = 0.044 for 1 year; OR, 1.093, 95% CI = 1.000-1.196, p = 0.005 for 3 years; OR, 1.094, 95% CI = 1.002-1.195, p = 0.045 for 5 years). However, significant associations were not found for the working hours period. In the female participants, during the midday period, the 1-, 3-, and 5-year average WBGT values per 1 ℃ increase were significantly negatively associated with eGFR < 60 ml/min/1.73 m 2 (OR, 0.872, 95% CI = 0.778-0.976, p = 0.018 for 1 year; OR, 0.874, 95% CI = 0.780-0.978, p = 0.019 for 3 years; OR, 0.875, 95% CI = 0.784-0.977, p = 0.018 for 5 years). In addition, during the working hours period, the 1-, 3-, and 5-year average WBGT values per 1 ℃ increase were also significantly negatively associated with eGFR < 60 ml/min/1.73 m 2 (OR, 0.856, 95% CI = 0.774-0.946, p = 0.002 for 1 year; OR, 0.856, 95% CI = 0.774-0.948, p = 0.003 for 3 years; OR, 0.853, 95% CI = 0.772-0.943, p = 0.002 for 5 years). In conclusion, our results revealed that increased WBGT was associated with impaired kidney function in males, whereas increased WBGT was associated with a protective effect against impaired kidney function in females. Further studies are needed to elucidate the exact mechanisms underlying these sex-specific differences., (© 2024. The Author(s).)

The worldwide prevalence and incidence rates of end-stage renal disease have been increasing, and the trend is pronounced in Taiwan. This is especially evident in southern Taiwan, where the wet-bulb globe temperature (WBGT) is consistently higher than in other regions. The association between kidney function and WBGT has not been fully investigated. Therefore, the aim of this study was to evaluate the association between estimated glomerular filtration rate (eGFR) and WBGT and variations in this association across different geographic regions in Taiwan. We used the Taiwan Biobank (TWB) to obtain data on community-dwelling individuals, linked these data with WBGT data obtained from the Central Weather Bureau and then processed the data using a machine learning model. WBGT data were recorded during the working period of the day from 8:00 a.m. to 5:00 p.m. These data were then compiled as 1-year, 3-year and 5-year averages, recorded prior to the survey year of the TWB of each participant. We identified 114 483 participants who had WBGT data during 2012-2020. Multivariable analysis showed that, in northern Taiwan, increases in 1- and 3-year averages of WBGT during the working period (β = -0.092, P  = .043 and β = -0.193, P  < .001, respectively) were significantly associated with low eGFR. In southern Taiwan, increases in 1-, 3- and 5-year averages of WBGT during the working period (β = -0.518, P  < .001; β = -0.690, P  < .001; and β = -0.386, P  = .001, respectively) were gnificantly associated with low eGFR. These findings highlight the importance of heat protection for people working outdoors or in high-temperature environments as a measure to prevent negative impacts on kidney function. Moreover, we observed that in southern Taiwan, every 1°C increase in WBGT had a greater impact on the decrease in eGFR compared with other regions in Taiwan., Competing Interests: The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Rationale and Objectives: Little is known about the factors affecting the Artificial Intelligence (AI) software performance on mammography for breast cancer detection. This study was to identify factors associated with abnormality scores assigned by the AI software., Materials and Methods: A retrospective database search was conducted to identify consecutive asymptomatic women who underwent breast cancer surgery between April 2016 and December 2019. A commercially available AI software (Lunit INSIGHT, MMG, Ver. 1.1.4.0) was used for preoperative mammography to assign individual abnormality scores to the lesions and score of 10 or higher was considered as positive detection by AI software. Radiologists without knowledge of the AI results retrospectively assessed the mammographic density and classified mammographic findings into positive and negative finding. General linear model (GLM) analysis was used to identify the clinical, pathological, and mammographic findings related to the abnormality scores, obtaining coefficient β values that represent the mean difference per unit or comparison with the reference value. Additionally, the reasons for non-detection by the AI software were investigated., Results: Among the 1001 index cancers (830 invasive cancers and 171 ductal carcinoma in situs) in 1001 patients, 717 (72%) were correctly detected by AI, while the remaining 284 (28%) were not detected. Multivariable GLM analysis showed that abnormal mammography findings (β = 77.0 for mass, β = 73.1 for calcification only, β = 49.4 for architectural distortion, and β = 47.6 for asymmetry compared to negative; all Ps < 0.001), invasive tumor size (β = 4.3 per 1 cm, P < 0.001), and human epidermal growth receptor type 2 (HER2) positivity (β = 9.2 compared to hormone receptor positive, HER2 negative, P = 0.004) were associated with higher mean abnormality score. AI failed to detect small asymmetries in extremely dense breasts, subcentimeter-sized or isodense lesions, and faint amorphous calcifications., Conclusion: Cancers with positive abnormal mammographic findings on retrospective review, large invasive size, HER2 positivity had high AI abnormality scores. Understanding the patterns of AI software performance is crucial for effectively integrating AI into clinical practice., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jung Min Chang reports was provided by Seoul National University Hospital., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)