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Background) Breast cancer is a leading cause of death worldwide. Tumor vascularity is a hallmark of cancer including breast cancer. However, targeting tumor vascularity did not show consistent benefit when applied in clinic. This study aimed to investigate in which group of patients can tumor vascularity be a prognostic factor and how does change of tumor vascularity play in this situation. Materials and methods) Female patients with breast cancer who received preoperative chemotherapy due to breast cancer between 2003 and 2018 at Wonju Severance Hospital, Korea, were included. Clinocopathological characteristics were collected. Hounsfield units(HU) on contrast-enhanced computed tomography(CT) was used as a marker indicating tumor vascularity. Tumor to aortic arch ratio(TAR) of HU on contrast enhanced CT was applied to enhance objectivity of measurement. Patients were categorized according to the cut-off values retrieved from the receiver operating characteristic curve. Kaplan-Meier curves were generated to compare recurrence-free interval (RFI) and overall survival (OS). Results) The final cohort included 162 patients with a mean age of 48.63±7.9 (30-69) years. Initial TAR was 0.38±0.103 (range, 0.184-0.946) and TAR after completion of preoperative systemic treatment was 0.29 0.094(0.677-0.298). Difference between TAR of immediate before surgery and first clinical presentation was -0.0860.094(-0.386 – 0.176). TAR was decreased in 122 (75.3%) patients. Initial TAR was significantly correlated with recurrence free survival(RFS)(p=0.002). However, TAR after preoperative systemic treatment (p=0.221) or delta TAR (area under receiver operating characteristics = 0.498) were not significant. Interestingly, initial TAR was significant only in patients with decreased TAR after preoperative systemic treatment(p=0.005). Conclusion) Tumor vascularity represented with HU was significantly related with patients’ survival only when tumor vascularity was decreased in response to systemic treatment. Considering no antiangiogenic agents were applied as preoperative systemic treatment and still capacity of tumor vascularity as a biomarker was influenced by the change of itself, antiangiogenic agents could be used as a complimentary agent for the other agents which also impact tumor vascularity. Citation Format: Hyang Suk Choi, Eun Ju Son, Hany Hany Noh, In-Jeong Cho In-Jeong Cho, Seung Taek Lim, Jong-In Lee, Airi Han. Performance of tumor vascularity as a biomarker is correlated with the change of tumor vascularity after preoperative systemic treatment in patients with breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-11-30.

To investigate the added diagnostic value of abbreviated breast magnetic resonance imaging (MRI) for suspicious microcalcifications on screening mammography. This prospective study included 80 patients with suspicious calcifications on screening mammography who underwent abbreviated MRI before undergoing breast biopsy between August 2017 and September 2020. The abbreviated protocol included one pre-contrast and the first post-contrast T1-weighted series. MRI examinations were interpreted as either positive or negative based on the visibility of any significant enhancement. The positive predictive value (PPV) was compared before and after the MRI. Of the 80 suspicious microcalcifications, 33.8% (27/80) were malignant and 66.2% (53/80) were false positives. Abbreviated MRI revealed 33 positive enhancement lesions, and 25 and two lesions showed true-positive and false-negative findings, respectively. Abbreviated MRI increased PPV from 33.8 (27 of 80 cases; 95% CI: 26.2%, 40.8%) to 75.8% (25 of 33 cases; 95% CI: 62.1%, 85.7%). A total of 85% (45 of 53) false-positive diagnoses were reduced after abbreviated MRI assessment. Abbreviated MRI added significant diagnostic value in patients with suspicious microcalcifications on screening mammography, as demonstrated by a significant increase in PPV with a potential reduction in unnecessary biopsy. • Abbreviated breast magnetic resonance imaging increased the positive predictive value of suspicious microcalcifications on screening mammography from 33.8 (27/80 cases) to 75.8% (25/33 cases) (p < .01). • Abbreviated magnetic resonance imaging helped avoid unnecessary benign biopsies in 85% (45/53 cases) of lesions without missing invasive cancer.

To develop and validate nomograms based on shear-wave elastography (SWE) combined with clinicopathologic features for predicting Oncotype DX recurrence score (RS) for use with adjuvant systemic therapy guidelines.In a retrospective study, patients with breast cancer who underwent definitive surgery of the breast between August 2011 and December 2019 were eligible for this study. Those with surgery between August 2011 and March 2019 were assigned to a development set and the rest were assigned to an independent validation set. Clinicopathologic features and SWE elasticity indices were assessed with logistic regression to develop nomograms for predicting RS ≥ 16 and ≥ 26. Analysis of the area under the receiver operating characteristic curve (AUROC) was used to assess the performance of the nomograms.Of a total 381 women (mean age, 51 ± 9 years), 286 (mean age, 51 ± 9 years) were in the development set and 95 (mean age, 51 ± 9 years) in the validation set. All SWE elasticity indices were independently associated with each RS cutoff (odds ratio, 1.006-1.039 for RS ≥ 16; odds ratio, 1.008-1.076 for RS ≥ 26). Nomograms based on SWE combined with clinicopathologic features were developed and validated for RS ≥ 16 (mean elasticity [AUROC, 0.74; 95% CI: 0.68, 0.80] and maximum elasticity [AUROC, 0.74; 95% CI: 0.69, 0.80]) and for RS ≥ 26 (mean elasticity [AUROC, 0.81; 95% CI: 0.73, 0.89], maximum elasticity [AUROC, 0.82; 95% CI: 0.74, 0.89], and elasticity ratio [AUROC, 0.86; 95% CI: 0.80, 0.93]).Nomograms based on SWE can predict Oncotype DX RS for use in adjuvant systemic therapy decisions.

To determine whether texture analysis for magnetic resonance imaging (MRI) can predict recurrence in patients with breast cancer treated with neoadjuvant chemotherapy (NAC). This retrospective study included 130 women who received NAC and underwent subsequent surgery for breast cancer between January 2012 and August 2017. We assessed common features, including standard morphologic MRI features and clinicopathologic features. We used a commercial software and analyzed texture features from pretreatment and midtreatment MRI. A random forest (RF) method was performed to build a model for predicting recurrence. The diagnostic performance of this model for predicting recurrence was assessed and compared with those of five other machine learning classifiers using the Wald test. Of the 130 women, 21 (16.2%) developed recurrence at a median follow-up of 35.4 months. The RF classifier with common features including clinicopathologic and morphologic MRI features showed the lowest diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.83). The texture analysis with the RF method showed the highest diagnostic performances for pretreatment T2-weighted images and midtreatment DWI and ADC maps showed better diagnostic performance than that of an analysis of common features (AUC, 0.94 vs. 0.83, p < 0.05). The RF model based on all sequences showed a better diagnostic performance for predicting recurrence than did the five other machine learning classifiers. Texture analysis using an RF model for pretreatment and midtreatment MRI may provide valuable prognostic information for predicting recurrence in patients with breast cancer treated with NAC and surgery. • RF model-based texture analysis showed a superior diagnostic performance than traditional MRI and clinicopathologic features (AUC, 0.94 vs.0.83, p < 0.05) for predicting recurrence in breast cancer after NAC. • Texture analysis using RF classifier showed the highest diagnostic performances (AUC, 0.94) for pretreatment T2-weighted images and midtreatment DWI and ADC maps. • RF model showed a better diagnostic performance for predicting recurrence than did the five other machine learning classifiers.

Background Since the 5th edition of BI-RADS was released, prior studies have compared BI-RADS and quantitative fully automated volumetric assessment, but with software packages that were not recalibrated according to the 5th edition. Purpose To investigate mammographic density assessment of automated volumetric measurements recalibrated according to the BI-RADS 5th edition compared with visual assessment. Material and Methods A total of 4000 full-field digital mammographic examinations were reviewed by three radiologists for the BI-RADS 5th edition density category by consensus after individual assessments. Volumetric density data obtained using Quantra and Volpara software were collected. The comparison of visual and volumetric density assessments was performed in total and according to the presence of cancer. Results Among 4000 examinations, 129 were mammograms of breast cancer. Compared to visual assessment, volumetric measurements showed higher category B (40.6% vs. 19.8%) in Quantra, and higher category D (40.4% vs. 14.7%) and lower category A (0.2% vs. 5.0%) in Volpara ( P Conclusion Automated volumetric measurements adapted for the BI-RADS 5th edition showed different but correlated results with visual assessment and each other. Recalibration of volumetric measurement has not completely reflected the visual assessment.

OBJECTIVE To develop a scoring system stratifying the malignancy risk of mammographic microcalcifications using the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS). MATERIALS AND METHODS One hundred ninety-four lesions with microcalcifications for which surgical excision was performed were independently reviewed by two radiologists according to the 5th edition of BI-RADS. Each category's positive predictive value (PPV) was calculated and a scoring system was developed using multivariate logistic regression. The scores for benign and malignant lesions or BI-RADS categories were compared using an independent t test or by ANOVA. The area under the receiver operating characteristic curve (AUROC) was assessed to determine the discriminatory ability of the scoring system. Our scoring system was validated using an external dataset. RESULTS After excision, 69 lesions were malignant (36%). The PPV of BI-RADS descriptors and categories for calcification showed significant differences. Using the developed scoring system, mean scores for benign and malignant lesions or BI-RADS categories were significantly different (p < 0.001). The AUROC of our scoring system was 0.874 (95% confidence interval, 0.840-0.909) and the PPV of each BI-RADS category determined by the scoring system was as follows: category 3 (0%), 4A (6.8%), 4B (19.0%), 4C (68.2%), and 5 (100%). The validation set showed an AUROC of 0.905 and PPVs of 0%, 8.3%, 11.9%, 68.3%, and 94.7% for categories 3, 4A, 4B, 4C, and 5, respectively. CONCLUSION A scoring system based on BI-RADS morphology and distribution descriptors could be used to stratify the malignancy risk of mammographic microcalcifications.

Considering the emergence of bacterial resistance and low proteolytic stability of antimicrobial peptides (AMPs), herein we developed a series of ultra-short triazine based amphipathic polymers (TZP) that are connected with ethylene diamine linkers instead of protease sensitive amide bond. The most potent oligomers, TZP3 and TZP5 not only displayed potent antibacterial action on various drug-resistant pathogens but also exhibited a strong synergic antibacterial activity in combination with chloramphenicol against multidrug-resistant Pseudomonas aeruginosa (MDRPA). Since most of atopic dermatitis (AD) infections are caused by bacterial colonization, we evaluated the potency of TZP3 and TZP5 on AD in vitro and in vivo. In vitro AD analysis of these two polymers showed significant inhibition against the release of β-hexosaminidase and tumor necrosis factor (TNF-α) from RBL-2H3 cells. In AD-like skin lesions in BALB/c mice model, these two polymers displayed significant potency in suppressing dermal and epidermal thickness, mast cell infiltration and pro-inflammatory cytokines expression. Moreover, these polymers exhibited remarkable efficacy over the allergies caused by the imbalance of Th1/Th2 by regulating total IgE and IgG2a. Finally, the impact of treatment effects of these polymers was examined through analyzing the weights and sizes of spleen and lymph node of AD-induced mice.

Purpose We evaluated the clinical value of breast magnetic resonance imaging (MRI) in patients who underwent breast-conserving surgery (BCS). The degree of correlation between pathology size and MRI or ultrasonography (US) size was compared based on breast cancer subtypes. In addition, we investigated the positive margin rates. Methods Patients with invasive breast cancer who underwent preoperative breast MRI and US between 2011 and 2016 were included in the study. Lin's concordance correlation coefficient was used to measure the correlation between MRI or US andpathologic tumor extent. Tumor extent was defined as pathologic tumor size, including in situ carcinoma. Margin positivity was assessed based on frozen-section examination. Results A total of 516 patients with a single tumor who underwent BCS were included in the study. The correlation between pathologic size and MRI was significantly higher than that of US (r = 0.6975 vs. 0.6211, p = 0.001). The superiority of MRI over US in measuring the pathologic extent was only observed in triple-negative breast cancer (TNBC; r = 0.8089 vs. 0.6014, p < 0.001). The agreement between MRI or US and tumor extent was low for the human epidermal growth factor receptor 2 (HER2)-positive subtype (MRI: 0.5243, US: 0.4898). Moreover, the positive margin rate was higher in the HER2-positive subtype than in the others (luminal/HER2-negative: 11.6%, HER2-positive: 23.2%, TNBC: 17.8%, p = 0.019). The post hoc analysis showed that the HER2-positive subtype was more likely to show positive margins than the luminal/HER2-negative subtype (p = 0.007). Conclusion Breast MRI was superior to US in the preoperative assessment of the pathologic extent of tumor size; this was most evident in TNBC. For HER2-positive tumors, imaging-pathologic discordance resulted in higher positive margin rates than that with other subtypes.

Early detection and accurate diagnosis are essential for the effective prevention and treatment of tumors. Optical imaging methods can provide real-time and high-resolution in vivo images for tumor diagnostic applications. Pro-Leu-His-Ser-Thr(PO3H2) (PLHSpT) is an inhibitor of polo-like kinase 1, which is overexpressed in various tumors, and the transactivator of transcription (TAT) is a peptide known to penetrate tumor cells. In this study, we used a fragment of the TAT sequence, YARVRRRGPRR, to produce a YARVRRRGPRR-conjugated PLHSpT peptide using solid-phase peptide synthesis. Subsequently, the cyanine 5 NHS ester (Cy5) fluorescent dye was attached to YARVRRRGPRRPLHSpT (1) to obtain the Cy5-YARVRRRGPRRPLHSpT peptide (2), which was used to identify tumor targets through optical imaging. 2 was injected into HeLa xenograft tumor-bearing mice. After in vivo imaging at 3 h, 6 h, and 24 h post-injection, mice were sacrificed for ex vivo fluorescence intensity assessment. Optical imaging scans of 2 revealed significantly high uptake by tumor cells at all in vivo scan times. The highest fluorescence intensity difference between tumor and muscles was observed at 6 h. Ex vivo results also showed a high variation in the tumor-to-muscle uptake ratios at 6 h. In conclusion, we synthesized and evaluated 2 for cancer diagnosis in mice. Our optical imaging results demonstrated that 2 has remarkable cancer-detection ability in vivo, establishing this peptide as a potential imaging probe for tumor diagnosis.

The aim of this study was to verify the effect of attachment and sharing time between parent and child and self-esteem on positive peer relationships in single parent family children. A total of 99 children from 4th to 6th graders in elementary school (45 boys, 45.5%) participated in the study. They responded to attachment and sharing time between parent and child, self-esteem, and positive peer relationships questionnaires. The data were analyzed using the Structural Equation Model Analysis. The results were as follows: Attachment and sharing time between parent and child had an indirect effect through self-esteem on positive peer relationships in single parent family children. Single parent family children who had secure attachments and had lots of sharing time with their parent showed a higher level of positive peer relationships. In addition, when children had a good relationship with their parent both quantitatively and qualitatively, they perceived self-esteem positively, which led to higher positive peer relationships. The findings of this research indicate that parent-child relationships play significant roles in predicting self-esteem and positive peer relationships in single parent family children.

The purpose of this study was to evaluate and compare the diagnostic performances of the deep convolutional neural network (CNN) and expert radiologists for differentiating thyroid nodules on ultrasonography (US), and to validate the results in multicenter data sets. This multicenter retrospective study collected 15,375 US images of thyroid nodules for algorithm development (n = 13,560, Severance Hospital, SH training set), the internal test (n = 634, SH test set), and the external test (n = 781, Samsung Medical Center, SMC set; n = 200, CHA Bundang Medical Center, CBMC set; n = 200, Kyung Hee University Hospital, KUH set). Two individual CNNs and two classification ensembles (CNNE1 and CNNE2) were tested to differentiate malignant and benign thyroid nodules. CNNs demonstrated high area under the curves (AUCs) to diagnose malignant thyroid nodules (0.898–0.937 for the internal test set and 0.821–0.885 for the external test sets). AUC was significantly higher for CNNE2 than radiologists in the SH test set (0.932 vs. 0.840, P P = 0.113, 0.126, and 0.690). CNN showed diagnostic performances comparable to expert radiologists for differentiating thyroid nodules on US in both the internal and external test sets.

Insertion of radiopaque markers is helpful for tumor localization in patients receiving neoadjuvant chemotherapy (NAC) followed by breast-conserving surgery (BCS). The aim of this retrospective study was to investigate the pathologic margin status in patients with single or double marker insertion. We reviewed the records of 130 patients with marker insertion prior to NAC followed by BCS from January 2016 to September 2019. Under ultrasonography guidance, single or double markers were inserted to localize a tumor in the breast. The incidence of additional resection after frozen biopsy and re-excision after permanent pathologic diagnosis was analyzed. In a total of 130 patients, 104 had a single marker in the center of the tumor and 26 had double markers at the periphery of the tumor before NAC. Among 69 patients with residual invasive tumors after NAC, there was no difference in the additional resection rate after frozen biopsy (single vs. double markers; 14.3% vs. 38.5%, P = .059) or the re-excision rate after final pathologic diagnosis (0% vs. 7.7%, P = .188). After propensity score matching for tumor size and subtypes, the two groups showed no differences in the additional resection rate after frozen biopsy (7.7% vs. 19.2%, P = .139) or the re-excision rate (0% vs. 3.8%, P = .308). After a median follow-up of 19 months (range 8–48 months), local recurrence-free survival did not differ between the two groups (log-rank P = .456). Number of inserted markers for tumor localization did not affect the pathologic margin status after BCS.

Aim To investigate whether magnetic resonance imaging (MRI) can improve the positive predictive value (PPV) for Breast Imaging-Reporting and Data System (BI-RADS) category 4B mammographic microcalcification. Materials and methods One hundred and eight consecutive patients with BI-RADS category 4B microcalcification without mass on mammography underwent breast MRI and subsequent histopathological confirmation between January 2009 and December 2015. Mammography and MRI findings were reviewed retrospectively, and imaging features were analysed according to the 5th edition of BI-RADS. The PPV of each descriptor was analysed to identify subgroups in which PPV could be improved by the addition of MRI. Results When the criteria of presence of enhancement on MRI was applied to category 4B microcalcification, PPV increased from 0.38 (41 of 108) to 0.82 (37 of 45) and reduced benign biopsy results by 88% (59 of 67). Four ductal carcinoma in situ lesions were missed. For amorphous microcalcification with regional or grouped distribution, MRI images increased PPV without missing malignancy. Conclusion Breast MRI has the potential to improve PPV for category 4B mammographic microcalcification by reducing false-positive findings. If amorphous microcalcification with regional or grouped distribution on mammography shows no enhancement on MRI, follow-up could be considered rather than immediate biopsy. In addition, breast MRI might have the potential to guide the best site to biopsy in category 4B microcalcification.

Glycogen-rich clear cell carcinoma (GRCC) of the breast is a rare malignant tumor. Most previous reports focused on clinicopathologic findings of GRCC and imaging findings were not precisely described. Here, we report imaging findings of three cases of GRCC along with a literature review. GRCC of the breast was depicted as a mass with irregular or oval shape on mammography and complex cystic and solid composition or focal cystic change on ultrasound. GRCC showed internal high signal intensity on T2-weighted MRI with rim enhancement after contrast injection. These might suggest the possibility of GRCC in differentiating breast tumors.

Background Previous studies have suggested that texture analysis is a promising tool in the diagnosis, characterization, and assessment of treatment response in various cancer types. Therefore, application of texture analysis may be helpful for early prediction of pathologic response in breast cancer. Purpose To investigate whether texture analysis of features from MRI is associated with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer. Materials and Methods This retrospective study included 136 women (mean age, 47.9 years; range, 31-70 years) who underwent NAC and subsequent surgery for breast cancer between January 2012 and August 2017. Patients were monitored with 3.0-T MRI before (pretreatment) and after (midtreatment) three or four cycles of NAC. Texture analysis was performed at pre- and midtreatment T2-weighted MRI, contrast material-enhanced T1-weighted MRI, diffusion-weighted MRI, and apparent diffusion coefficient (ADC) mapping by using commercial software. A random forest method was applied to build a predictive model for classifying those with pCR with use of texture parameters. Diagnostic performance for predicting pCR was assessed and compared with that of six other machine learning classifiers (adaptive boosting, decision tree, k-nearest neighbor, linear support vector machine, naive Bayes, and linear discriminant analysis) by using the Wald test and DeLong method. Results Forty of the 136 patients (29%) achieved pCR after NAC. In the prediction of pCR, the random forest classifier showed the lowest diagnostic performance with pretreatment ADC (area under the receiver operating characteristic curve [AUC], 0.53; 95% confidence interval: 0.44, 0.61) and the highest diagnostic performance with midtreatment contrast-enhanced T1-weighted MRI (AUC, 0.82; 95% confidence interval: 0.74, 0.88) among pre- and midtreatment T2-weighted MRI, contrast-enhanced T1-weighted MRI, diffusion-weighted MRI, and ADC mapping. Conclusion Texture parameters using a random forest method of contrast-enhanced T1-weighted MRI at midtreatment of neoadjuvant chemotherapy were valuable and associated with pathologic complete response in breast cancer. © RSNA, 2019 Online supplemental material is available for this article.

Purpose There is still a clinical need to easily evaluate the metastatic status of lymph nodes during breast cancer surgery. We hypothesized that ex vivo shear-wave elastography (SWE) would predict precisely the presence of metastasis in the excised lymph nodes. Methods A total of 63 patients who underwent breast cancer surgery were prospectively enrolled in this study from May 2014 to April 2015. The excised axillary lymph nodes were examined using ex vivo SWE. Metastatic status was confirmed based on the final histopathological diagnosis of the permanent section. Lymph node characteristics and elasticity values measured by ex vivo SWE were assessed for possible association with nodal metastasis. Results A total of 274 lymph nodes, harvested from 63 patients, were examined using ex vivo SWE. The data obtained from 228 of these nodes from 55 patients were included in the analysis. Results showed that 187 lymph nodes (82.0%) were nonmetastatic and 41 lymph nodes (18.0%) were metastatic. There was significant difference between metastatic and nonmetastatic nodes with respect to the mean (45.4 kPa and 17.7 kPa, p

OBJECTIVES To assess the impact of the background parenchymal echotexture on the accuracy of tumor size estimation using breast ultrasound (US). METHODS A total of 140 women with newly diagnosed invasive breast cancer from January 2014 to December 2015 were enrolled in this study. Two radiologists retrospectively reviewed US images in consensus for background parenchymal echotexture interpretation. The maximum tumor diameter from static images was recorded. Tumor size measurements were considered as having agreement with histologic results if they were within ±5 mm compared to the pathologic size. The relationship between the accuracy of tumor size measurement by the background parenchymal echotexture and clinicopathologic characteristics was evaluated. RESULTS Of these 140 patients, 77 (55.0%) showed a homogeneous background parenchymal echotexture, whereas 63 (45.0%) showed a heterogeneous echotexture. The mean tumor size was 1.9 cm (range, 0.5-4.9 cm). The overall accuracy of tumor size measurement was 76.4% (104 of 140). Tumors of women with a homogeneous background parenchymal echotexture were more accurately measured than those of women with a heterogeneous echotexture (87.0% versus 63.5%; P = .001). Tumors with a small size (

Simple Summary The presence of lateral neck lymph node (LN) metastasis (N1b) is a known prognostic factor for poor prognosis and high morbidity after surgery in papillary thyroid carcinoma (PTC). Previous studies have suggested that tumor size and metastatic LN characteristics, including LN size, number, ratio, and extranodal extension, are associated with recurrence; however, the prognostic role of imaging features of LNs in the lateral neck have rarely been reported. In this study, we investigated whether ultrasound imaging features of lateral neck LN metastases can be prognostic markers for predicting recurrence and thereby guide surgical extent and posttreatment surveillance in N1b PTC. Abstract This study aimed to investigate whether preoperative ultrasonographic (US) features of metastatic lymph nodes (LNs) are associated with tumor recurrence in patients with N1b papillary thyroid carcinoma (PTC). We enrolled 692 patients (mean age, 41.9 years; range, 6–80 years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015 and were followed-up for 12 months or longer. Clinicopathologic findings and US features of the index tumor and metastatic LNs in the lateral neck were reviewed. A Kaplan-Meier analysis and Cox proportion hazard model were used to analyze the recurrence-free survival rates and features associated with postoperative recurrence. Thirty-seven (5.3%) patients had developed recurrence at a median follow-up of 66.5 months. On multivariate Cox proportional hazard analysis, male sex (hazard ratio [HR], 2.277; 95% confidence interval [CI]: 1.131, 4.586; p = 0.021), age ≥55 years (HR, 3.216; 95% CI: 1.529, 6.766; p = 0.002), LN size (HR, 1.054; 95% CI: 1.024, 1.085; p < 0.001), and hyperechogenicity of LN (HR, 8.223; 95% CI: 1.689, 40.046; p = 0.009) on US were independently associated with recurrence. Preoperative US features of LNs, including size and hyperechogenicity, may be valuable for predicting recurrence in patients with N1b PTC.

Background Various size and shape of region of interest (ROI) can be applied for shear-wave elastography (SWE). Purpose To investigate the diagnostic performance of SWE according to ROI settings for breast masses. Material and Methods To measure elasticity for 142 lesions, ROIs were set as follows: circular ROIs 1 mm (ROI-1), 2 mm (ROI-2), and 3 mm (ROI-3) in diameter placed over the stiffest part of the mass; freehand ROIs drawn by tracing the border of mass (ROI-M) and the area of peritumoral increased stiffness (ROI-MR); and circular ROIs placed within the mass (ROI-C) and to encompass the area of peritumoral increased stiffness (ROI-CR). Mean (Emean), maximum (Emax), and standard deviation (ESD) of elasticity values and their areas under the receiver operating characteristic (ROC) curve (AUCs) for diagnostic performance were compared. Results Means of Emean and ESD significantly differed between ROI-1, ROI-2, and ROI-3 ( P max did not ( P = 0.50). For ESD, ROI-1 (0.874) showed a lower AUC than ROI-2 (0.964) and ROI-3 (0.975) ( P SD was significantly different between ROI-M and ROI-MR and between ROI-C and ROI-CR ( P SD in ROI-M and ROI-C were significantly lower than in ROI-MR ( P = 0.041 and 0.015) and ROI-CR ( P = 0.007 and 0.004). Conclusion Shear-wave elasticity values and their diagnostic performance vary based on ROI settings and elasticity indices. Emax is recommended for the ROIs over the stiffest part of mass and an ROI encompassing the peritumoral area of increased stiffness is recommended for elastic heterogeneity of mass.

Shear-wave elastography (SWE) is a recently developed ultrasound technique that can visualize and measure tissue elasticity. In breast ultrasonography, SWE has been shown to be useful for differentiating benign breast lesions from malignant breast lesions, and it has been suggested that SWE enhances the diagnostic performance of ultrasonography, potentially improving the specificity of conventional ultrasonography using the Breast Imaging Reporting and Data System criteria. More recently, not only has SWE been proven useful for the diagnosis of breast cancer, but has also been shown to provide valuable information that can be used as a preoperative predictor of the prognosis or response to chemotherapy.

To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients. BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards. Of the 626 lesions, morphological features included a single focus in 26.5% (n = 166), multiple foci in 47.1% (n = 295), mass in 21.7% (n = 136) and non-mass enhancement in 4.6% (n = 29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29–66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA. Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers. • BI-RADS category 3 lesions on preoperative MRI had 0.8% malignancy rate. • All cancer diagnoses from BI-RADS 3 occurred after 24-month follow-up. • Annual follow-up might be adequate for BI-RADS 3 detected on preoperative MRI.

This study was designed to assess the outcomes of subcentimeter thyroid nodules with highly suspicious ultrasonography (US) features and to investigate the predictive factors associated with malignancy and aggressive biological behavior to determine appropriate candidate factors for active surveillance. Between June 2011 and December 2013, 1866 subcentimeter thyroid nodules with highly suspicious US features that were subjected to US-guided fine needle aspiration and subsequent surgery or US follow-up of at least 2 years were evaluated. A multivariate logistic regression analysis was performed to identify independent clinical characteristics and US features associated with the malignancy rate and aggressive biological behavior. Of the 1866 subcentimeter thyroid nodules, 821 (44.0%) were benign and 1045 (56.0%) were malignant. Age younger than 45 years, presence of microcalcification, and a taller than wide shape on US were associated independently with malignancy in the subcentimeter thyroid nodules (P

To investigate whether monitoring with ultrasound and MR imaging before, during and after neoadjuvant chemotherapy (NAC) can predict axillary response in breast cancer patients. A total of 131 breast cancer patients with clinically positive axillary lymph node (LN) who underwent NAC and subsequent surgery were enrolled. They had ultrasound and 3.0 T-MR examinations before, during and after NAC. After reviewing ultrasound and MR images, axillary LN features and tumour size (T size) were noted. According to LN status after surgery, imaging features and their diagnostic performances were analysed. Of the 131 patients, 60 (45.8%) had positive LNs after surgery. Pre-NAC T size at ultrasound and MR was different in positive LN status after surgery (p

ObjectiveTo develop a nomogram and validate its use for the intraoperative evaluation of nodal metastasis using shear-wave elastography (SWE) elasticity values and nodal sizeMethodsWe constructed a nomogram to predict metastasis using ex vivo SWE values and ultrasound features of 228 axillary LNs from fifty-five patients. We validated its use in an independent cohort comprising 80 patients. In the validation cohort, a total of 217 sentinel LNs were included.ResultsWe developed the nomogram using the nodal size and elasticity values of the development cohort to predict LN metastasis; the area under the curve (AUC) was 0.856 (95% confidence interval (CI), 0.783–0.929). In the validation cohort, 15 (7%) LNs were metastatic, and 202 (93%) were non-metastatic. The mean stiffness (23.54 and 10.41 kPa,p= 0.005) and elasticity ratio (3.24 and 1.49,p= 0.028) were significantly higher in the metastatic LNs than those in the non-metastatic LNs. However, the mean size of the metastatic LNs was not significantly larger than that of the non-metastatic LNs (8.70 mm vs 7.20 mm, respectively;p= 0.123). The AUC was 0.791 (95% CI, 0.668–0.915) in the validation cohort, and the calibration plots of the nomogram showed good agreement.ConclusionsWe developed a well-validated nomogram to predict LN metastasis. This nomogram, mainly based on ex vivo SWE values, can help evaluate nodal metastasis during surgery.Key Points• A nomogram was developed based on axillary LN size and ex vivo SWE values such as mean stiffness and elasticity ratio to easily predict axillary LN metastasis during breast cancer surgery.• The constructed nomogram presented high predictive performance of sentinel LN metastasis with an independent cohort.• This nomogram can reduce unnecessary intraoperative frozen section which increases the surgical time and costs in breast cancer patients.

This study aimed to investigate whether the elasticity index of shear-wave elastography (SWE) can predict cervical lymph node (LN) metastasis of papillary thyroid carcinoma (PTC). This retrospective study included 363 patients with a surgical diagnosis of PTC who underwent preoperative SWE evaluation. The elasticity indices of PTC (E mean, E max, E min, E ratio-p, and E ratio-m) and gray-scale ultrasound (US) parameters (extrathyroidal extension, multifocality, and cervical LN metastasis) were correlated with the pathologic staging parameters. The optimal cutoff values for the elasticity indices were determined for the prediction of cervical LN metastasis, and diagnostic performance was compared between gray-scale US and the combined application of gray-scale US and SWE. The findings showed E mean and E max to be associated with central LN metastasis (P = 0.037) and E min to be associated with lateral LN metastasis (P = 0.015). An E mean value higher than 124 kPa or an E max value higher than 138 kPa with suspicious gray-scale US findings improved the sensitivity and area under the curve (AUC) for predicting central LN metastasis (sensitivity, 45.4 and 44.6 % vs. 28 %, P

Purpose: The goal of this study was to assess the clinicopathologic and ultrasonographic features of thyroid nodules with nondiagnostic results on repeat ultrasonography (US)-guided fineneedle aspiration biopsy (FNAB) according to size and the number of suspicious findings and to determine the proper management of nodules with consecutive nondiagnostic results. Methods: This retrospective study included 297 nodules with nondiagnostic results on repeat FNAB that were evaluated by US over the course of at least 12 months of follow-up, a follow-up biopsy, or an operation. We compared clinical and US variables between benign and malignant nodules in thyroid nodules with repeat nondiagnostic results. Results: The comparison of benign and malignant nodules with repeat nondiagnostic results revealed that age, marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, and nonparallel shape were significantly associated with malignancy. Multivariate logistic regression analysis in malignant nodules revealed that microcalcifications and irregular or microlobulated margins were independently associated with malignancy. Among them, only irregular or microlobulated margins were independently significant as a predictor of malignancy in repeatedly nondiagnostic nodules measuring >10 mm. Using receiver operating characteristic analysis, the best cutoff value for the “number of suspicious findings” between benign and malignant nodules was three in nodules of all sizes, three in nodules measuring ≤10 mm, and two in nodules measuring >10 mm. Conclusion: Irregular or microlobulated margins may be the most frequent US features in repeatedly nondiagnostic nodules >10 mm. The presence of “two or more suspicious findings” can be used as the cutoff for distinguishing benign and malignant nodules.

Background The purpose of this study was to investigate the role of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) as a prognostic marker in conventional papillary thyroid carcinoma (PTC). Methods A total of 397 patients who underwent ultrasound-guided fine-needle aspiration biopsy (FNAB) and surgery for conventional PTCs were enrolled. The association between the Bethesda category and histopathologic result was evaluated. Results Among the Bethesda categories, a significant difference was found in the presence of extrathyroidal extension (Bethesda category III, 3.2% [7 of 220]; category V, 19.1% [42 of 220]; and category VI, 77.7% [171 of 220]; p < .001) and lymph node metastasis (Bethesda category III, 3.8% [6 of 156]; category V, 16.7% [26 of 156]; and category VI, 79.5% [124 of 156]; p < .001). Multivariate analysis showed that the Bethesda category was independently predictive of extrathyroidal extension (p = .013) and lymph node metastasis (p = .035). Conclusion Conventional PTC with a higher Bethesda category at the time of cytology diagnosis would be poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Purpose The goal of this study was to evaluate the clinicopathological and imaging features of thyroid nodules surgically diagnosed as hyaline trabecular tumor (HTT), and to assess the role of cytology and frozen sections (FS) in the diagnosis of HTT. Methods This study included 21 thyroid nodules in 21 patients treated from August 2005 to March 2015 (mean age, 53.3 years) who were either diagnosed as HTT or had HTT suggested as a possible diagnosis based on cytology, FS, or the final pathology report. Patients' medical records were retrospectively reviewed for cytopathologic results and outcomes during the course of follow-up. Sonograms were reviewed and categorized. Results Twelve nodules from 12 patients were surgically confirmed as HTT. Ultrasonography (US)-guided fine needle aspiration (FNA) was performed on 11 nodules, of which six (54.5%) were papillary thyroid carcinoma (PTC) or suspicious for PTC and three (27.3%) were HTT or suspicious for HTT. Intraoperative FS suggested the possibility of HTT in seven nodules, of which four (57.1%) were confirmed as HTT. US-FNA suggested the diagnosis of HTT in 10 nodules, of which three (30.0%) were confirmed as HTT. Common US features of the 12 pathologically confirmed cases of HTT were hypoechogenicity or marked hypoechogenicity (83.4%), absence of calcifications (91.7%), parallel shape (100.0%), presence of vascularity (75.0%), and probable benignity (58.3%). Conclusion HTT should be included in the differential diagnosis of solid tumors with hypoechogenicity or marked hypoechogenicity and otherwise benign US features that have been diagnosed as PTC through cytology.