Abstract Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive, low-to-intermediate grade fibroblastic neoplasm arising from the skin that can uncommonly involve the breast and mimic primary breast malignancy. Dermatofibrosarcoma protuberans of the breast typically presents as a palpable, slow-growing superficial mass with an associated flesh-colored or red-brown skin lesion. On mammography, DFSP most often demonstrates an oval, circumscribed, equal or high-density mass. Ultrasound typically shows an oval hypoechoic or heterogeneous circumscribed mass, frequently with internal hypervascularity. MRI commonly demonstrates a superficial mass without circumscribed margins, with T1 hypointensity, T2 hyperintensity, and avid heterogeneous or homogeneous enhancement. Histologically, DFSP demonstrates uniform spindle cells in a storiform pattern with infiltrative extension into subcutaneous fat; immunochemistry is characteristically CD34-positive. Molecular testing can confirm the diagnosis by identifying a platelet-derived growth factor receptor Beta (PDGFB) fusion (classically collagen type I alpha 1 gene [COL1A1]: PDGFB) and may be helpful in limited sampling or atypical morphology. Treatment is complete surgical resection with negative margins, with re-excision for positive margins. Although local recurrence can occur, metastasis is uncommon, and long-term disease specific survival is excellent. Careful radiologic-pathologic correlation facilitates accurate diagnosis, concordance assessment after biopsy, and appropriate management.
Abstract Objective To assess whether changes in optoacoustic/ultrasound (OA/US) imaging features during neoadjuvant chemotherapy (NAC) correlate with treatment response, compared to US-derived tumor volumetric changes. Methods In this IRB-approved, HIPAA-compliant prospective study, 20 patients with cT1–T4, cN1–3 breast cancer underwent serial OA/US imaging at baseline, post-cycle 1, mid-therapy, and presurgery. Optoacoustic/US features, including internal vessels (OAint), internal hemoglobin (OAHb), deoxyHb, peripheral zone (OApz), and boundary zone (OAbz) were assessed using a validated scoring system. US tumor volume and OA/US changes were compared to residual cancer burden (RCB) and pathologic complete response (pCR). Responders were defined as RCB 0–II; non-responders were defined as RCB III. Comparisons were made using Wilcoxon Rank-Sum tests and univariate logistic regression. Results Mean age was 50.4 years (SD ± 9.5). Mean tumor size was 26.3 mm (SD ± 9.7). Pathology showed pCR in 6 (30%), partial response in 11 (55%), and no response in 3 (15%), with mean overall residual tumor cellularity of 32.7% (SD ± 33.5). Regression analysis showed no significant correlation between percent volume change and pCR at cycle1 or mid-therapy. Patients achieving pCR had significantly lower residual OAHb after cycle 1 (76.4% vs 108.8%, P = 0.01). At preoperative, all OA/US features decreased significantly more in pCR vs non-pCR cases (all P < 0.05). Higher individual and total OA/US scores at cycle 1 reflecting elevated hemoglobin and lower relative oxygen saturation predicted RCB III status. The RCB III tumors had significantly higher mean residual deoxygenated blush score at cycle 1 (117.8% vs 64.8%, P = 0.03). Conclusion Optoacoustic/US feature changes were more highly correlated with pCR than US volumetric decrease and show promise as a potential tool to non-invasively identify pCR. Early cycle 1 OA/US scores may help identify poor responders.
Abstract Breast MRI is an essential tool for breast cancer detection, evaluation, and characterization, offering greater sensitivity than mammography and ultrasound. Normal breast tissue demonstrates variable enhancement on MRI, known as background parenchymal enhancement (BPE), which reflects the physiologic enhancement of fibroglandular tissue after gadolinium administration. Initially considered an incidental finding, BPE is now recognized as a dynamic imaging feature influenced by several factors, including age, menopausal status, exogenous hormone use, and prior breast cancer treatments. Increasing evidence supports its clinical relevance since variations in BPE have been associated with differences in breast cancer risk, lesion detection, and imaging interpretation. Background parenchymal enhancement (BPE) is emerging as an important imaging biomarker with potential applications in risk stratification, evaluation of disease extent, and monitoring response to neoadjuvant therapy. Differences in BPE patterns may also correlate with tumor biology and molecular subtypes, further supporting its role in personalized breast imaging assessment. This article provides a comprehensive review of BPE, highlighting its biologic basis, imaging characteristics, and clinical implications in breast cancer care. It also examines the evolving role of artificial intelligence tools in the assessment and quantification of BPE, which may improve standardization and integration into clinical decision-making and research.
