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OBJECTIVES: High background parenchymal enhancement (BPE) levels and asymmetric distribution could cause diagnostic uncertainty due to morphological similarity to breast cancer, especially invasive lobular carcinoma (ILC). We investigated BPE in ILC patients, its association with the tumor hormonal profile, and the effect of endocrine treatment (ET). METHODS: The analysis included all MRI examinations performed at our institution between 2010 and 2019 for ILC-diagnosed patients. Baseline study and the first follow-up study were reviewed. Digital medical records were reviewed to retrieve demographics/pathology results/treatment information. BPE and fibroglandular tissue were assessed qualitatively on the contralateral breast according to the criteria of the Breast Imaging Reporting and Data System (BI-RADS). RESULTS: The study included 129 patients. Most (91%) had pure ILC. All received ET; 12% also received chemotherapy; 90% had surgery first; 70% by breast conservation. On the baseline MRI, 70% had mild or moderate BPE; whereas, on the follow-up study, the majority (59%) had minimal BPE. Most BPE reductions were by 2 degrees. In the baseline study, additional biopsies were required in 59% of cases, and in 17%, a short-term follow-up was recommended. In the follow-up study, biopsies were recommended in 10%, and a short-term follow-up was requested in 16%. A correlation between progesterone receptor intensity index and baseline BPE level was observed (r = 0.3, p = 0.004). CONCLUSION: ILC patients usually exhibit high BPE. ET decreases BPE, and therefore may decrease false-positive interpretations. Additional research is needed to explore whether study can be performed on ET without compromising sensitivity. Key points: ∙ High background parenchymal enhancement levels reduces breast MRI sensitivity, yielding high false positive rates especially when reporting cases of invasive lobular carcinoma [ILC]. ∙Treatment of ILC with endocrine therapy reduces background parenchymal enhancement and thus could decrease these false-positive interpretations.

Purpose: To evaluate the total biopsy and positive biopsy rates in women at high risk of breast cancer compared to the general population. Methods: The study group consisted of 330 BRCA mutation carriers attending the dedicated multidisciplinary breast cancer clinic of a tertiary medical center in Israel. Clinical, genetic, and biopsy data were retrieved from the central healthcare database and the medical files. Patients who were at age 50 years or older during follow-up were matched 1:10 to women in the general population referred for routine breast cancer screening at the same age, as recommended in the international guidelines. The groups were compared for rate of biopsy studies performed and percentage of positive biopsy results. Matched analysis was performed to correct for confounders. Results: The matched analysis revealed that the total biopsy rate per 1000 follow-up-years was 61.7 in the study group and 22.7 in the control group (p Citation Format: Adi Pomerantz, Daliah Tsoref, Ahuva Grubstein, Sonya Wadhawker, Yael Rapson, Itay Gadiel, Hadar Goldvaser, Ariel Hammerman, Tzipora Shochat, Eran Sharon, Rinat Yerushalmi. Rate of breast biopsy referrals in BRCA mutation carriers: A retrospective comparative study and matched analysis [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-16.

Objectives In the midst of the coronavirus disease 2019 (COVID-19) outbreak, chest X-ray (CXR) imaging is playing an important role in diagnosis and monitoring of patients with COVID-19. We propose a deep learning model for detection of COVID-19 from CXRs, as well as a tool for retrieving similar patients according to the model’s results on their CXRs. For training and evaluating our model, we collected CXRs from inpatients hospitalized in four different hospitals. Methods In this retrospective study, 1384 frontal CXRs, of COVID-19 confirmed patients imaged between March and August 2020, and 1024 matching CXRs of non-COVID patients imaged before the pandemic, were collected and used to build a deep learning classifier for detecting patients positive for COVID-19. The classifier consists of an ensemble of pre-trained deep neural networks (DNNS), specifically, ReNet34, ReNet50¸ ReNet152, and vgg16, and is enhanced by data augmentation and lung segmentation. We further implemented a nearest-neighbors algorithm that uses DNN-based image embeddings to retrieve the images most similar to a given image. Results Our model achieved accuracy of 90.3%, (95% CI: 86.3–93.7%) specificity of 90% (95% CI: 84.3–94%), and sensitivity of 90.5% (95% CI: 85–94%) on a test dataset comprising 15% (350/2326) of the original images. The AUC of the ROC curve is 0.96 (95% CI: 0.93–0.97). Conclusion We provide deep learning models, trained and evaluated on CXRs that can assist medical efforts and reduce medical staff workload in handling COVID-19. Key Points • A machine learning model was able to detect chest X-ray (CXR) images of patients tested positive for COVID-19 with accuracy and detection rate above 90%. • A tool was created for finding existing CXR images with imaging characteristics most similar to a given CXR, according to the model’s image embeddings. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08050-1.

Background Breast cancer patients with lymph node (LN) metastases at diagnosis often undergo neoadjuvant therapy (NAT). Identification of a LN which regressed after NAT remains a challenge. Objective To evaluate marking of involved nodes by tattooing with carbon suspension, and identifying these nodes during surgery. Methods A small amount (0.2–0.5 ml) of carbon suspension was injected into one or two axillary LNs under ultrasound guidance at the time of LN biopsy or before or shortly after starting NAT for LN positive breast cancer. During surgery an attempt was made to identify and remove the tattooed LN as a separate specimen. All patients underwent sentinel LN mapping and biopsy and/or axillary LN dissection as mandated by their clinical status. Results Sixty three patients underwent tattooing of axillary LNs with no complications or adverse events. At surgery a tattooed node was identified in 60 patients (95%; 95% CI 87, 98). Of 56 patients who underwent sentinel mapping with Tc99, in 51 (91%; 95% CI 81, 96) at least one radioactive LN was identified. Of 50 patients in whom both radioactivity and tattoo were identified in axillary LNs, in 40 (80%; 95% CI 67, 89) LNs were radioactive and tattooed, however in 10 patients (20%; 95% CI 11, 33), the tattooed LN was not radioactive. Conclusions Tattooing of axillary LNs is safe and easily performed. Tattooing was helpful in identifying the marked LN in the majority of cases. This technique helps to ensure that metastatic LNs are identified and removed at surgery after NAT.

Women who carry the BRCA mutation are at high lifetime risk of breast cancer, but there is no consensus regarding an effective and safe chemoprevention strategy. A large body of evidence suggests that 3,3-diindolylmethane (DIM), a dimer of indole-3-carbinol found in cruciferous vegetables, can potentially prevent carcinogenesis and tumor development. The primary aim of this prospective single-arm study was to investigate the effect of DIM supplementation on breast density, a recognized predictive factor of breast cancer risk. Participants were 23 healthy female BRCA carriers (median age 47 years; 78% postmenopausal) who were treated with oral DIM 100 mg × 1/day for 1 year. The amount of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI) performed before and after the intervention was scored by two independent expert radiologists using the Breast Imaging and Reporting Data System. The results showed a decrease in the average score for FGT amount from 2.8 ± 0.8 at the onset to 2.65 ± 0.84 after 1 year (P = 0.031), with no significant change in BPE (P = 0.429). A group of DIM-untreated age- and menopausal-status-matched women from the BRCA clinic did not show a significant change in FGT amount (P = 0.33) or BPE (P = 0.814) in a parallel year. Mean estradiol level decreased from 159 to 102 pmol/l (P = 0.01), and mean testosterone level decreased from 0.42 to 0.31 pmol/l (P = 0.007). Side effects were grade 1. In conclusion, 1 year’s supplementation with DIM 100 mg × 1/day in BRCA carriers was associated with a significant decline in FGT amount on MRI. Larger randomized studies are warranted to corroborate these findings., The impact of 1 year’s supplementation with oral 3,3-diindolylmethane 100 mg × 1/day on breast density and estrogen metabolism was evaluated in 23 healthy BRCA carriers. MRI showed a significant decrease in average Breast Imaging and Reporting Data System score for fibroglandular tissue from before to after treatment.

Mammography as a screening tool can reduce mortality from breast cancer. Nevertheless, it has disadvantages such as false positive results, false negative, impaired sensitivity in women with dense breast over-diagnosis and radiation. Due to the different weight given to the advantages versus the disadvantages of mammography, different approaches to screening have developed. These range from annual screening starting at the age of 40 years, to biannual screening starting at the age of 50. The official screening program in Israel is biannual screening between the ages of 50 and 74.

PurposeTo evaluate the total biopsy and positive biopsy rates in women at high risk of breast cancer compared to the general population.MethodsThe study group consisted of 330 women with pathogenic variants (PVs) inBRCA1/2attending the dedicated multidisciplinary breast cancer clinic of a tertiary medical center in Israel. Clinical, genetic, and biopsy data were retrieved from the central healthcare database and the medical files. Patients aged 50 years or older during follow-up were matched 1:10 to women in the general population referred for routine breast cancer screening at the same age, as recommended by international guidelines. The groups were compared for rate of biopsy studies performed and percentage of positive biopsy results. Matched analysis was performed to correct for confounders.ResultsThe total biopsy rate per 1000 follow-up years was 61.7 in the study group and 22.7 in the control group (p p p ConclusionWomen aged 50 + years with PVs inBRCA1/2attending a dedicated clinic have a 2.7 times higher biopsy rate per 1000 follow-up years, a 13.2 times higher positive biopsy rate per 1000 follow-up years, and a 4.9 times higher positive biopsy percentage than same-aged women in the general population.

Purpose To evaluate the total biopsy and positive biopsy rates in women at high risk of breast cancer compared to the general population. Methods The study group consisted of 330 BRCA mutation carriers attending the dedicated multidisciplinary breast cancer clinic of a tertiary medical center in Israel. Clinical, genetic, and biopsy data were retrieved from the central healthcare database and the medical files. Patients who were at age 50 years or older during follow-up were matched 1:10 to women in the general population referred for routine breast cancer screening at the same age, as recommended in the international guidelines. The groups were compared for rate of biopsy studies performed and percentage of positive biopsy results. Matched analysis was performed to correct for confounders. Results The matched analysis revealed that the total biopsy rate per 1000 follow-up-years was 61.7 in the study group and 22.7 in the control group (p p p BRCA mutation carriers who attend a dedicated clinic, have a 2.7 times higher biopsy rate per 1000 follow-up-years, a 13.2 times higher positive biopsy rate per 1000 follow-up-years, and a 4.9 times higher positive biopsy percentage compared with women in the general population.

In the midst of the coronavirus disease 2019 (COVID-19) outbreak, chest X-ray (CXR) imaging is playing an important role in the diagnosis and monitoring of patients with COVID-19. Machine learning solutions have been shown to be useful for X-ray analysis and classification in a range of medical contexts. The purpose of this study is to create and evaluate a machine learning model for diagnosis of COVID-19, and to provide a tool for searching for similar patients according to their X-ray scans. In this retrospective study, a classifier was built using a pre-trained deep learning model (ReNet50) and enhanced by data augmentation and lung segmentation to detect COVID-19 in frontal CXR images collected between January 2018 and July 2020 in four hospitals in Israel. A nearest-neighbors algorithm was implemented based on the network results that identifies the images most similar to a given image. The model was evaluated using accuracy, sensitivity, area under the curve (AUC) of receiver operating characteristic (ROC) curve and of the precision-recall (P-R) curve. The dataset sourced for this study includes 2362 CXRs, balanced for positive and negative COVID-19, from 1384 patients (63 +/- 18 years, 552 men). Our model achieved 89.7% (314/350) accuracy and 87.1% (156/179) sensitivity in classification of COVID-19 on a test dataset comprising 15% (350 of 2326) of the original data, with AUC of ROC 0.95 and AUC of the P-R curve 0.94. For each image we retrieve images with the most similar DNN-based image embeddings; these can be used to compare with previous cases., Elisha Goldstein, Daphna Keidar, and Daniel Yaron have made an equal contribution and are equal first authors, listed alphabetically

Neoadjuvant therapy (NAT) is increasingly used in breast cancer (BC), yet, the recommended time interval between NAT completion, preoperative imaging assessment, and breast surgery is not clearly defined. This single-center retrospective study investigated tumor growth between NAT completion and surgery. The analysis included 106 BC patients who received NAT (69% chemotherapy alone, 31% chemotherapy plus anti-HER2 therapy), had post-NAT breast MRI, and definitive surgery between 2012 and 2019. The median time interval between end-of-treatment and surgery was 6 weeks; 90% had surgery within 8 weeks of NAT completion, and 10% had surgery 8-12 weeks after NAT completion. No significant correlation was found between any of the time intervals (i.e., NAT completion-to-surgery, NAT completion-to-MRI, post-NAT MRI to surgery) and the tumor size as captured in the pathology report. The only parameter that was significantly correlated with pathological tumor size was tumor size as measured on the post NAT MRI (P .0001). The difference in tumor size between post NAT MRI and surgical pathology did not correlate with the time interval between end-of-treatment and surgery. The ratio between residual tumor size on post-NAT MRI and the time interval from the end-of-treatment to surgery, significantly correlated with the tumor size on surgical pathology (P .0001) suggesting that NAT has a beneficial effect weeks after end-of-treatment. In conclusion, our results suggest that for patients undergoing neoadjuvant chemotherapy, surgery within 4-8 weeks of completing NAT is reasonable, and is unlikely to result in a clinically significant change in residual tumor size.

INTRODUCTION Breast and chest wall desmoid tumours can cause debilitating symptoms and deformity. The mutilating effects of surgical treatment have prompted a shift to medical treatments and even to a wait-and-see approach. This study sought to highlight specific characteristics of breast and chest wall desmoid tumours on long-term follow-up by sequential MRI scans. METHODS Thirty-two breast MRI scans from six patients with chest wall or breast desmoid tumours followed up for up to 6 years were retrospectively reviewed. RESULTS All patients underwent breast surgery prior to the development of the desmoid tumour. Five of the patients had reconstruction or augmentation using silicone implants. Two desmoids were treated primarily with surgery, three with medical means and one is under wait-and-see approach. On MRI, tumours appeared either oval and lobulated (chest wall) or spiculated with architectural distortion (breast). Chest wall desmoids demonstrated both an enhancing high-T2-signal component and a non-enhancing low-T2- signal component. The histologically defined phases during the course of desmoid tumours (progression, regression, residual disease) could be demonstrated by corresponding MRI changes in each of the components. CONCLUSIONS Magnetic resonance imaging delineates the complex infiltrative features of chest wall and breast desmoid tumours. In tumours with a bright cellular enhancing and dark collagenous non-enhancing component, treatment response may be predicted by changes on serial T2-weighted sequences, beyond the tumour-dimension-based RECIST assessment alone.

Background To assess the reasons for false-negative readings of automated breast ultrasound (ABUS) studies. Methods Between 2012 and 2015, 1,890 ABUS studies were performed at our tertiary medical center. Those for which false-negative results were documented in the initial ABUS report against the corresponding hand-held ultrasound (HHUS) scan were reviewed by three specialized breast radiologists. Key images of specific lesions were marked on the ABUS and HHUS scans and compared for quality (equal, better with HHUS, better with ABUS). Readers were also asked to identify the reasons for the differences in image quality between the scans: poor visibility, lesion location, or fibroglandular tissue shadowing. Results Twenty-two ABUS studies met the study criteria. Two of the three readers found that most lesions were better demonstrated with HHUS. Overall agreement among the readers was moderate (kappa 0.36, SD 0.15, p = 0.002). Highest agreement was found for better image quality for HHUS than ABUS (kappa 0.4, SD 1.3, p = 0.0007). Of the four biopsy-proven carcinomas, three were found by all three readers to be better depicted with HHUS; two were located peripherally and were not seen by ABUS. For all readers, the most common reason for false-negative readings was poor visibility, followed by peripheral lesion location and shadowing obscuring the lesion. Conclusions Several factors may make reading ABUS images difficult. Resolution can be diminished by imperfect transducer-breast contact, and fibrotic breasts can cause artifacts such as marked shadowing. Peripheral lesions may be missed because of blind spots. Reader training and experience may play an important role in managing these issues. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:245–251, 2017

Background: With approximately 1.6 million annual procedures in the United States and 3 million world-wide, needle biopsy is considered the Gold Standard for breast cancer diagnosis and treatment planning. Overdiagnosis can result in unnecessary treatment, cost, and anxiety, while underdiagnosis can delay treatment and diminish outcomes. A 2015 study published in JAMA1 found nearly 25% discordance between pathology diagnosis and expert review, most pronounced in cases of DCIS, Atypia and in patients with dense breasts. It has been well established that physiologic differences between benign and malignant tissues are reflected in their electrical properties.2,3,4 Access to real-time tissue properties during the biopsy procedure has the potential for increasing accuracy by enabling the most suspicious tissue to be sampled, and by providing the tissue characterization to pathology for comparison with histologic findings. Through research made possible by the European Union’s Horizon 2020 research award, this feasibility study sought to determine if five 0.8mm miniaturized, flexible RF sensors (Dune Medical Devices, Alpharetta, GA) mounted within the sample cavity of a 14-gauge biopsy needle can accurately measure and map the electrical properties of multiple breast tissue types. Methods: Between March, 2018 and March, 2019, 44 patients undergoing mastectomy or lumpectomy at three medical centers in Israel were enrolled in the study. The biopsy needle was applied to freshly excised specimens, with continuous readings by the sensors. An average of 8.1 cores (ranging from 2-10) were obtained from each specimen. Cores were oriented and analyzed by standard histopathology. Based on histology, the dielectric properties of the various tissue types were derived, and the ability of the device to differentiate between malignant and non-malignant tissue was assessed. Results: A total of 357 cores from 44 specimens were analyzed. Ease of use and quality of tissue samples were equivalent to that of a standard biopsy needle. The dielectric properties of three tissue groups: Fat, Healthy non-Fat, and Malignant, in the low radiofrequency range were measured, showing distinct differences between the various types. Feature sizes larger than 0.8 mm were analyzed. The differentiation ability between tissue types was characterized using sensitivity and specificity of 85% and 99% respectively. Conclusions: Miniature, flexible RF sensors can be incorporated onto a biopsy needle. Although this study utilized a 14-gauge core needle, the 0.8mm sensor size allows for configuration within both vacuum-assisted and core biopsy needles of various gauges. The dielectric properties of breast tissue can be assessed in real-time during the biopsy procedure. These results show promise in differentiating between breast tissue types, specifically cancerous and benign, enabling more accurate tissue sampling and subsequent diagnosis. Improving the accuracy of breast biopsies should provide immediate clinical impact by reducing overstaging and subsequent unneeded treatment, procedures and cost, as well as reducing understaging of breast cancer which results in delayed diagnosis and missed cancer. Forward-looking, real-time tissue characterization during biopsy could prove especially beneficial should newer protocols currently under trial, such as active surveillance for low risk DCIS5 and omission of surgery for exceptional responders of neoadjuvant chemotherapy,6 become treatment options. The ability to mount the sensors to minimally invasive treatment devices will lay the foundation for expanding the technology to other cancer types, with the potential for precision delivery of new targeted drugs, radiation and ablation therapies at the site of the cancer. Citation Format: Noemi Weisenberg, Avihai Lachman, Lisa Cadena, Inbal Shimens, Olga Shmain, Ahuva Grubstein, Yael Rapson, Hana Cernik, Debora Kidron, Tania Zehavi, Evgeny Edelstein, Vladimir Kravtsov, Tatiana Kogan, Meirav Wolff Bar, Judith Diment, Ilana Haas, Patricia Malinger, Eran Sharon, Yehudit Birnbaum, Ada Magen, Yael Sobol, Osnat Givon Madhala, Sonya Wadhawker, Tanir M Allweis. Feasibility of incorporating miniaturized, flexible radiofrequency (RF) sensors in a breast biopsy needle for accurate real-time characterization of benign and malignant tissue [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-04-01.

Background: The aim of this study was to characterize the signs of invasive lobular carcinoma of the breast on digital breast tomosynthesis (DBT) imaging. Patients and Methods: The study group included 23 women with pathologically proven invasive lobular carcinoma of the breast for whom both digital mammography (DM) and DBT images were available. The images were read jointly by 2 experienced breast radiologists. Findings were recorded according to the descriptors in the Breast Imaging and Reporting Data System lexicon and correlated with the detailed pathology results. Results: In 21 of the 23 patients, the combination of DM and DBT yielded pathologic findings (91%). Architectural distortions or spiculations were demonstrated in 87% of cases. The addition of DBT to DM improved lesion detection by more clearly depicting both the lesion margins and architectural distortions. Only 2 lesions were occult by both DM and DBT, including 1 lesion in a peripheral location that was not incorporated in the standard mediolateral oblique and craniocaudal views. Conclusion: DBT improves the detection of invasive lobular carcinoma lesions by more clearly depicting architectural distortions and spiculations.

1556 Background: Women who carry the BRCA mutation are at high lifetime risk of breast cancer, but there is no consensus regarding an effective and safe chemoprevention strategy. A large body of evidence suggests that 3,3-diindolylmethane (DIM), a dimer of indole-3-carbinol (I3C) found in cruciferous vegetables, can potentially prevent carcinogenesis and tumor development. The primary aim of this prospective study was to investigate the effect of DIM supplementation on breast density, a recognized predictive factor of breast-cancer risk. Methods: Participants were 23 healthy female BRCA carriers (median age 47 years; 78% postmenopausal) who were treated with oral DIM 100 mgx1/d for one year. The amount of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI) performed before and after the intervention were scored by two independent expert radiologists using the Breast Imaging and Reporting Data System (BI-RADS). Each woman in the cohort was matched by age (within 3 years) and menopausal status to a woman attending the clinic who was not participating in the study and who underwent breast MRI in parallel year. Results: A decrease in the average score for FGT amount from 2.8±0.8 at onset to 2.65±0.842.8 after one year (p = 0.031), with no significant change in BPE (p = 0.429). A group of DIM-untreated age- and menopausal-status-matched clinic patients did not show a significant change in FGT amount (p = 0.33) or BPE (p = 0.814) in a parallel year. Mean estradiol level decreased from 159 to 102 pmol/L (p = 0.01), and mean testosterone level, from 0.42 to 0.31 pmol/L (p = 0.007). Side effects were grade 1. Conclusions: One year’s supplementation with DIM 100 mgX1/d in BRCA carriers was associated with a significant decline in FGT amount on MRI. Larger randomized studies are warranted to corroborate these findings. Clinical trial information: NCT02197000.

Introduction: Tubular adenomas are rare benign epithelial neoplasms of the breast resembling fibroadenomas on both imaging and pathology. We aimed at characterizing and differentiating these lesions on contrast enhanced mammography and MRI.Material and methods: Out of all percutaneous breast biopsies performed at the Rabin medical center between the years 2010-2019, five cases which also had contrast-based imaging including contrast enhanced mammography and MRI were retrieved. Morphology and enhancement patterns of the lesions were analyzed by two dedicated breast radiologists.Results: The contrast imaging characteristics of all lesions were enhancing masses measuring 4-17 mm. The shape of the lesions was oval, borders well circumscribed, on both CEM and MRI. CEM revealed marked homogenous enhancement. MRI enhancement patterns of the small tumors showed homogenous enhancement, whereas the larger mass showed a more heterogeneous enhancement. Kinetic curves on MRI were of rapid marked enhancement.Conclusion: Tubular adenomas diverge pathologically from known enhancement patterns of fibroadenomas.

To assess the reasons for false-negative readings of automated breast ultrasound (ABUS) studies.Between 2012 and 2015, 1,890 ABUS studies were performed at our tertiary medical center. Those for which false-negative results were documented in the initial ABUS report against the corresponding hand-held ultrasound (HHUS) scan were reviewed by three specialized breast radiologists. Key images of specific lesions were marked on the ABUS and HHUS scans and compared for quality (equal, better with HHUS, better with ABUS). Readers were also asked to identify the reasons for the differences in image quality between the scans: poor visibility, lesion location, or fibroglandular tissue shadowing.Twenty-two ABUS studies met the study criteria. Two of the three readers found that most lesions were better demonstrated with HHUS. Overall agreement among the readers was moderate (kappa 0.36, SD 0.15, p = 0.002). Highest agreement was found for better image quality for HHUS than ABUS (kappa 0.4, SD 1.3, p = 0.0007). Of the four biopsy-proven carcinomas, three were found by all three readers to be better depicted with HHUS; two were located peripherally and were not seen by ABUS. For all readers, the most common reason for false-negative readings was poor visibility, followed by peripheral lesion location and shadowing obscuring the lesion.Several factors may make reading ABUS images difficult. Resolution can be diminished by imperfect transducer-breast contact, and fibrotic breasts can cause artifacts such as marked shadowing. Peripheral lesions may be missed because of blind spots. Reader training and experience may play an important role in managing these issues. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:245-251, 2017.

We evaluated 18F-FDG PET/CT in small cell lung cancer (SCLC) staging and assessed metabolic (SUVmax, MTV and TLG) and morphologic (CTvol) variables as predictors for overall survival (OS) and progression-free survival (PFS). Patients with newly diagnosed, histopathology-confirmed SCLC, who underwent 18F-FDG PET/CT were evaluated. A Cox proportional hazard model was used to determine the association between the primary tumour SUVmax, MTV, TLG and CTvol with OS and PFS. Similar evaluations were performed when hilar/mediastinal lymphadenopathy was included [total SUVmax (TSUVmax), total MTV (TMTV) and total TLG (TTLG)]. 55 patients were included. 18F-FDG PET/CT changed staging in 6/55 (10.9%) patients who were upstaged to extensive disease. TTLG (>443.8) was a significant variable for OS with HR=2.1 (CI 1.14–3.871, p=0.017). Patients with TTLG>443.8 had a median OS of 13.4 months compared to 25.7 months in patients with TTLG 72.4) was significant for PFS with HR=2.3 (CI 1.11-4.8, p=0.025). A median PFS of 12.1 and 26.2 months was found with TMTV greater and less than 72.4, respectively (p=0.005). 18F-FDG PET/CT improved staging of patients with SCLC, and TTLG and TMTV can be used as prognostic variables for OS and PFS, respectively. • Identifying variables that predict the prognosis of patients with SCLC is important. • 18F-FDG PET/CT influences staging of patients with SCLC. • Metabolic parameters could be used as predictors for PFS and OS.

6611 Background: Although frequently used, there is no randomized data assessing the role of PET CT in the staging process of SCLC patients, or its impact on patients’ management. We aimed to revie...