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Chemotherapy has remained the mainstay of treatment of triple-negative breast cancer; however, it is significantly limited by the associated side effects. PD-1/PD-L1 immune checkpoint inhibition therapy (ICI) has been a breakthrough for this patient population in recent years. PD-L1 expression is crucial in immunotherapy since it is a major predictor of PD-1/PD-L1 antibody response, emphasizing the significance of monitoring PD-L1 expression. Nonetheless, it is hard to assess the expression of PD-L1 before surgery, which has highlighted the urgency for a precise and noninvasive approach. Herein, we prepared a dual-mode imaging nanoparticle probe to detect PD-L1. The particle size, zeta potential, biocompatibility, and imaging ability of NPs were characterized. The synthesized NPs showed slight cytotoxicity and good T2 relaxivity. The targeted NPs accumulated more in 4T1 cells than nontargeted NPs in vitro. The in vivo experiment further demonstrated the distribution of targeted NPs in tumor tissues, with changes in NIRF and MR signals observed. Our study indicated that SPIO-aPD-L1-Cy5.5 NPs can be used to monitor PD-L1 expression in breast cancer as NIRF/MR contrast agents.

Disagreement in assessments of Ki67 expression based on core-needle biopsy and matched surgical samples complicates decisions in the treatment of breast cancer.To examine whether preoperative breast MRI could be useful in predicting Ki67 discordance between core-needle biopsy and surgical samples.Retrospective.Three hundred and sixty-five breast cancer patients with MRI scans and having both core-needle biopsy and surgical samples from 2017 to 2019.3.0 T, T2-weighted iterative decomposition of water and fat with echo asymmetry and least squares estimation sequence, diffusion-weighted sequence using b-values 0/1000, dynamic contrast enhanced image by volume imaged breast assessme NT.We collected clinicopathologic variables and preoperative MRI features (tumor size, lesion type, shape of mass, spiculated margin, internal enhancement, peri-tumoral edema, intra-tumoral necrosis, multifocal/multicentric, apparent diffusion coefficient [ADC] minimum, ADC mean, ADC maximum, ADC difference).K-means clustering, multivariable logistic regression, receiver operating characteristic curve.Sixty-one patients showed Ki67 discordance and 304 patients show Ki67 concordance according to our definition using K-means clustering. Multivariable regression analysis showed that the following parameters were independently associated with Ki67 discordance: peri-tumoral edema, odds ratio (OR) 2.662, 95% confidence interval (CI) 1.432-4.948; ADCmin ≤ 0.829 × 10Presence of peri-tumoral edema, smaller ADCmin and greater ADCdiff in preoperative breast MRI may indicate high risk of Ki67 discordance between core-needle biopsy and surgical samples. For patients with these MRI-based risk factors, clinicians should not rely on Ki67 assessment only from core-needle biopsy.

Background Cancer diagnosis and treatment during the early stages of disease remain extremely challenging clinical tasks. The development of effective multimode contrast agents could greatly facilitate the early detection of cancer. Materials and methods We prepared dual-mode contrast agents using a biotin/avidin bioamplification system. Through in vivo and in vitro experiments, we verified the imaging performance of this contrast agents in both fluorescence and ultrasound and its targeting specificity for MDA-MB-231 cells. Results The RGD peptide-labelled microbubbles showed excellent targeting of αvβ3 integrin expressed by MDA-MB-231 cells in vitro and in vivo. The signal intensity and time duration of ultrasound imaging using these particles were superior to those obtained with a typical ultrasound contrast agent in the clinic. The tumour areas also demonstrated high Cy5.5 accumulation by fluorescence imaging. Conclusion The results show that this targeted dual-mode imaging system yields outstanding US/NIRF imaging results, possibly allowing the early clinical diagnosis of cancer.

Zhenhui Nie,1,* Ningbin Luo,1,* Junjie Liu,2 Yu Zhang,1 Xinyi Zeng,1 Danke Su1 1Department of Radiology, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 2Department of Medical Ultrasound, Affiliated Tumour Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Danke Su Email sudanke@gxmu.edu.cnBackground: Cancer diagnosis and treatment during the early stages of disease remain extremely challenging clinical tasks. The development of effective multimode contrast agents could greatly facilitate the early detection of cancer.Materials and Methods: We prepared dual-mode contrast agents using a biotin/avidin bioamplification system. Through in vivo and in vitro experiments, we verified the imaging performance of this contrast agents in both fluorescence and ultrasound and its targeting specificity for MDA-MB-231 cells.Results: The RGD peptide-labelled microbubbles showed excellent targeting of αvβ 3 integrin expressed by MDA-MB-231 cells in vitro and in vivo. The signal intensity and time duration of ultrasound imaging using these particles were superior to those obtained with a typical ultrasound contrast agent in the clinic. The tumour areas also demonstrated high Cy5.5 accumulation by fluorescence imaging.Conclusion: The results show that this targeted dual-mode imaging system yields outstanding US/NIRF imaging results, possibly allowing the early clinical diagnosis of cancer.Keywords: ultrasound, molecular imaging, microbubble, targeting imaging

Posthepatectomy liver failure (PHLF) is a challenging complication after resection to treat hepatocellular carcinoma (HCC), and it is associated with high mortality. Preoperative prediction of PHLF may improve patient subsequent and reduce such mortality. This study examined whether a functional liver imaging score (FLIS) based on preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI) could predict PHLF.The study included 502 patients who underwent preoperative gadoxetic acid-enhanced MRI, followed by HCC resection. Significant preoperative predictors of PHLF were identified using logistic regression analysis. The ability of FLIS to predict PHLF was evaluated using receiver operating characteristic curves, and its predictive power was compared to that of the model for end-stage liver disease (MELD) score, albumin-bilirubin (ALBI) score, and indocyanine green 15-min retention rate (ICG-R15).In multivariate analysis, PHLF was independently associated with FLIS (OR 0.452, 95% CI 0.361 to 0.568, p0.001) and major resection (OR 1.898, 95% CI 1.057 to 3.408, p = 0.032). FLIS was associated with a higher area under the receiver operating characteristic curve (0.752) than the MELD score (0.557), ALBI score (0.609), or ICG-R15 (0.605) (all p0.05). Patients with FLIS ≤ 4 who underwent major resection were at 9.4-fold higher risk of PHLF than patients with lower FLIS who underwent minor resection.FLIS is an independent predictor of PHLF, and it may perform better than the MELD score, ALBI score, and ICG-R15 clearance. We propose treating elevated FLIS and major resection as risk factors for PHLF.• A functional liver imaging score can independently predict posthepatectomy liver failure in patients with HCC. • The score may predict such failure better than MELD and ALBI scores and ICG-R15. • Patients with scores ≤ 4 who undergo major hepatic resection may be at nearly tenfold higher risk of posthepatectomy liver failure.

Rationale and Objectives To evaluate possible correlation between changes in apparent diffusion coefficient (ADC) and Ki-67 index as a result of neoadjuvant chemotherapy (NAC) in patients with invasive breast cancer. Methods and Materials Between February 2016 and October 2017, 87 patients with breast cancer underwent diffusion-weighted magnetic resonance imaging (b = 0 and 800 sec/mm2) before and after NAC. ADC and tumor diameter before and after NAC were compared to the Ki-67 index determined from biopsy or surgical specimens. Results Ki-67 index did not correlate significantly with ADC before NAC (p = 0.862) or afterwards (p = 0.292), nor did it correlate with tumor diameter before (p = 0.545) or afterwards (p = 0.478). However, change in ADC as a result of NAC correlated inversely with change in Ki-67 index (r = −0.326, p = 0.002). The percentage change in Ki-67 index did not correlate with the percentage change in ADC (p = 0.404). Similarly, the change in Ki-67 index or percentage change in that index did not correlate with the change in tumor diameter (p = 0.075) or percentage change in tumor diameter (p = 0.233). Conclusion Comparison of pre- and post-NAC ADC can be used to estimate the change in Ki-67 index in patients with invasive breast cancer.

To investigate whether normalized iodine concentration (NIC) correlates with tumor microvessel density and early recurrence in patients with HCC. We included 71 patients with surgically resected single HCC in this prospective study who underwent preoperative spectral CT between November 2014 and June 2016. Two observers independently measured the NIC in the arterial phase (AP) and portal venous phase (PVP). The relationship between NIC and microvessel density was evaluated. Univariate and multivariate logistic regression was performed to evaluate independent predictors of early recurrence. Early recurrence occurred in 28 of 71 patients (39.4%) during the 2-year follow-up. NIC-AP positively correlated with microvessel density for the two observers (r = 0.593 and 0.527). Based on multivariate analysis, independent risk factors for early HCC recurrence were tumor size (odds ratio, 1.200; p = 0.043) and NIC-AP (odds ratio, 2.522; p = 0.005). For the two observers, areas under the receiver operating characteristic curve for predicting early HCC recurrence were 0.719 and 0.677. Early recurrence rates were significantly higher among patients with NIC-AP values higher than the optimal cutoff than among those with values below the cutoff. Normalized iodine concentration in the arterial phase from spectral CT reflects tumor-derived angiogenesis and is a potential predictive biomarker for early recurrence of hepatocellular carcinoma. • Normalized iodine concentration in the arterial phase positively correlated with microvessel density of hepatocellular carcinoma. • In the patients with hepatocellular carcinoma, tumor size and normalized iodine concentration in the arterial phase were independent risk factors for early hepatocellular carcinoma recurrence. • Early hepatocellular carcinoma recurrence rates were significantly higher when normalized iodine concentration in the arterial phase values was above the optimal cutoff.

Tumor recurrence is a major cause of nasopharyngeal carcinoma (NPC) treatment failure. Diffusion-weighted imaging (DWI) is used for a variety of cancers, but few data are available for NPC. The aim of the study was to investigate the DWI features of recurrent NPC after radiotherapy and apparent diffusion coefficient (ADC) thresholds for the diagnosis of recurrent NPC. This was a retrospective study of 160 patients with NPC treated by radiotherapy at the Cancer Hospital affiliated to Guangxi Medical University from May 2012 to March 2015. The patients were divided into the local recurrence (n = 39), fibrosis (n = 51), clivus recurrence (n = 22), and clivus nonrecurrence (n = 48) groups. The patients underwent magnetic resonance imaging (MRI), enhanced MRI, and DWI. Receiver operating characteristics curves were used to determine sensitivity, specificity, and negative predictive values. ADC values were significantly different between the recurrence and fibrosis groups (P

Observational studies have reported controversial results on the association between GSTT1 and GSTM1 genotypes and treatment outcome of breast cancer. The purpose of this study is to evaluate the association between GSTT1 and GSTM1 and treatment outcome in breast cancer patients. Eligible studies were searched in PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases. A random-effect model or fixed-effect model was used to calculate the overall combined risk estimates. Twenty-one studies with a total of 4990 patients were included in this meta-analysis. The GSTM1 null genotype (odds ratio (OR) = 1.33, 95 % confidence interval (CI) 1.01-1.75, P = 0.046) and GSTT1/GSTM1 double null genotype (OR = 2.22, 95 % CI 1.02-4.84, P = 0.045) were significantly associated with an increased tumor response. A reduced overall survival (hazard ratio (HR) = 0.84, 95 % CI 0.72-0.98, P = 0.024) was observed in GSTM1 null genotype, especially in mixed descent (HR = 0.77, 95 % CI 0.61-0.96, P = 0.018) and large sample size (HR = 0.85, 95 % CI 0.72-0.99, P = 0.033). Evidence of publication bias was observed in GSTM1 genotype rather than in GSTT1 genotype. This meta-analysis suggests that GSTM1 null and GSTT1/GSTM1 double null polymorphisms might be significantly associated with an increased tumor response. However, the GSTM1 null genotype might be significantly associated with a reduced overall survival. Future studies are warranted to confirm these findings.

To determine the value of non-enhanced MRI in combination with color Doppler flow imaging (CDFI) for differentiating malignant parotid tumors from benign ones. This retrospective study analyzed 51 parotid gland lesions (39 benign and 12 malignant) in 51 patients who underwent preoperative CDFI as well as non-enhanced MRI including T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI). Degrees of intratumor vascularity were categorized into four grades basing on CDFI findings. The relationships between the lesion and its adjacent external carotid artery and retromandibular vein were inspected on T1-weighted and T2-weighted images. Apparent diffusion coefficient (ADC) values were calculated from diffusion-weighted images, and were used to classify the parotid gland lesions with and without reference to the CDFI findings. The classification results were compared using the McNemar test. Sensitivity, specificity, and accuracy percentages were calculated when the non-enhanced MRI/CDFI findings were used to differentiate benign lesions from malignant ones. The diagnostic accuracy (96.1 vs 82.4%) was significantly improved when ADCs were used together with CDFI findings for classifying parotid gland lesions compared to when ADCs were used alone. Pleomorphic adenomas had the highest ADCs. The ADC thresholds were 1.425 × 10−3 mm2/s for differentiating pleomorphic adenomas from carcinomas, 0.999 × 10−3 mm2/s for differentiating pleomorphic adenomas from other benign lesions, and 0.590 × 10−3 mm2/s for differentiating benign lesions other than pleomorphic adenomas from lymphomas. Combining CDFI with non-enhanced MRI can improve the diagnostic accuracy of MRI for classifying parotid gland lesions.

Purpose To evaluate the ratios of apparent diffusion coefficient (ADC) calculated from diffusion weighted imaging (DWI) between axillary lymph nodes with primary breast tumor lesions in the detection of axillary lymph nodes metastasis in breast cancer patients. Materials and Methods A total of 36 patients with breast tumors and their axillary lymph nodes were included in this study for MR image scan. The ADC values were calculated using DW-MR imaging software. The ADC values and the ADC ratios of axillary lymph nodes in patients with primary breast lesion were compared among benign and metastatic axillary lymph nodes. All the diagnosis were confirmed by histopathological examination. Results The mean ADC value of metastatic lymph nodes was significantly lower than those of benign lymph nodes (0.787 × 10−3 mm2/s ± 0.145 versus 1.043 × 10−3 mm2/s ± 0.257) (P < 0.05). In addition, ADC ratio of metastatic lymph nodes with breast lesion was significantly lower than those of benign lymph nodes with breast tumor lesions (0.986 ± 0.17 versus 1.375 ± 0.417) (P < 0.05). Once the ADC ratio was fixed at 0.889 × 10−3 mm2/s, the sensitivity, specificity, and accuracy were 82.22%, 82.35% and 82.28%, respectively. The cutoff of ADC ratio was at 1.097 × 10−3 mm2/s, the sensitivity, specificity, and accuracy can be up to 84.44%, 88.24%, and 86.08%. Conclusion ADC value and ADC ratio could be used as a reliable parameter to detect the axillary lymph nodes metastasis in breast cancer patients, and ADC ratio has a higher accuracy. J. Magn. Reson. Imaging 2013;38:824–828. © 2013 Wiley Periodicals, Inc.

Background Indocyanine green (ICG) is widely used as a tracer in sentinel lymph node biopsy (SLNB) of patients with breast cancer. Whether SLNB performance can be improved by supplementing ICG with methylene blue dye remains controversial. This study compared the performance of SLNB when ICG was used alone or with blue dye. Materials and methods Consecutive patients with T1-3 primary breast cancer at our hospital were recruited into our study and randomized to undergo SLNB with ICG alone ( n = 62) or with the combination of ICG and blue dye ( n = 65). We compared the two methods in terms of identification rate, number and detection time of sentinel lymph nodes (SLNs) removed. Results SLN identification rate were similar in the absence (95.2%) or presence of blue dye (98.5%, P = 0.578) but significantly, more average nodes were removed when blue dye was used (3.8 ± 1.5 versus 2.7 ± 1.2, P = 0.000), and the average time for detecting each SLN was significantly shorter (3.91 ± 1.87 versus 5.65 ± 2.95 min; P = 0.000). No patient in the study experienced severe adverse reactions or complications. Recurrence of axillary node was detected in one patient (1.6%) using ICG alone but not in any patients using ICG and blue dye. Conclusions The efficiency and sensitivity of SLNB can be improved by combining ICG with blue dye.

To evaluate the ratios of apparent diffusion coefficient (ADC) calculated from diffusion weighted imaging (DWI) between axillary lymph nodes with primary breast tumor lesions in the detection of axillary lymph nodes metastasis in breast cancer patients.A total of 36 patients with breast tumors and their axillary lymph nodes were included in this study for MR image scan. The ADC values were calculated using DW-MR imaging software. The ADC values and the ADC ratios of axillary lymph nodes in patients with primary breast lesion were compared among benign and metastatic axillary lymph nodes. All the diagnosis were confirmed by histopathological examination.The mean ADC value of metastatic lymph nodes was significantly lower than those of benign lymph nodes (0.787 × 10(-3) mm(2)/s ± 0.145 versus 1.043 × 10(-3) mm(2)/s ± 0.257) (P0.05). In addition, ADC ratio of metastatic lymph nodes with breast lesion was significantly lower than those of benign lymph nodes with breast tumor lesions (0.986 ± 0.17 versus 1.375 ± 0.417) (P0.05). Once the ADC ratio was fixed at 0.889 × 10(-3) mm(2)/s, the sensitivity, specificity, and accuracy were 82.22%, 82.35% and 82.28%, respectively. The cutoff of ADC ratio was at 1.097 × 10(-3) mm(2)/s, the sensitivity, specificity, and accuracy can be up to 84.44%, 88.24%, and 86.08%.ADC value and ADC ratio could be used as a reliable parameter to detect the axillary lymph nodes metastasis in breast cancer patients, and ADC ratio has a higher accuracy.