Distributions of risk factors and Volpara mamographic density measurements by menopausal status and body mass index in women from Beijing, China.

Distributions of mammographic density measurements: total breast volume(TBV), absolute dense volume (ADV), non-dense volume (NDV), and percent dense volume (PDV) in each BI-RADS category and their correlations with one another.

Associations between lifestyle factors and absolute dense volume (ADV), non-dense volume (NDV), and percent dense volume (PDV).

Background: Increased mammographic density (MD) is a known breast cancer risk factor, but its influencing factors are unclear in Asian populations. This study examined the links between known breast cancer risk factors and quantitatively measured MD in 7,351 Chinese women with nonmalignant mammographic findings.Methods: VolparaDensity software quantified volumetric MD measures: total breast volume (TBV), absolute dense volume (ADV), percent dense volume (PDV = ADV/TBV), and nondense volume (NDV = TBV - ADV). Multivariable linear regression models assessed associations between these MD metrics and breast cancer risk factors.Results: The mean age of the population was 50.1 (SD = 8.3) years. The mean ADV, NDV, and PDV were 58.4 cm3 (SD = 32.1), 382.8 cm3 (SD = 202.0), and 14.8 % (SD = 7.1), respectively. PDV was inversely associated with age, weight, body mass index (BMI), parity, breastfeeding duration, and postmenopausal status but positively linked to height and age at menopause. NDV showed opposite associations. ADV had similar associations to PDV, except for height, weight, and BMI, which differed for women with the lowest NDV. PDV associations with age at menarche, age at first birth, and breastfeeding duration varied by BMI and menopausal status.Conclusions: MD may influence the relationships between reproductive factors and breast cancer risk, depending on MD measure, menopausal status, and BMI.Impact: This study examines how quantitative MD measures relate to known breast cancer risk factors in an East Asian population, factoring in menopausal status and BMI. The results underscore the complex role of MD and confounding factors in breast cancer risk, highlighting the need for tailored insights for future research and screening.

3533 Background: There is a lack of standardization in the comprehensive treatment strategies for rectal cancer with lateral lymph node metastasis (LLNM), which results in an unfavorable oncological outcome. We conducted the present phase II trial by performing neoadjuvant chemotherapy with 5-fluorouracil, irinotecan, and oxaliplatin (FOLFOXIRI) regimen plus lateral lymph node dissection (LLND) for resectable rectal cancer with LLNM to decrease the lateral recurrence and distant metastasis rates. Methods: This prospective, single-arm phase II trial was conducted from April 2018 to February 2023, and included patients with cT3-4aN+M0 resectable rectal cancer and clinical suspicion of LLNM based on preoperative MRI. Patients were treated with three cycles of FOLFOXIRI, and those with evidence of treatment response continued to receive two cycles of FOLFOXIRI. Total mesorectal excision plus LLND was performed at 3-4 weeks after completing the last cycle of preoperative chemotherapy, followed by 3 cycles of XELOX. Results: A total of 58 patients engaged in this research, and 53 were finally enrolled. The pathological examination detected microscopic LLNM in 12 (22.6%) patients. The pathologic complete response (pCR) rate was 11.3% (6/53), and the downstaging (ypstage 0 to 1) rate was 30.2% (16/53). DFS events were observed in 7 patients, and OS events were reported in 2 patients after a median follow-up of 30 months. The 3-year DFS rate was 88.3%, the 3-year local recurrence-free survival rate was 94.7%, and the 3-year OS rate was 91.3%. There were 14 (26.4%) cases with six grade 3/4 adverse events. Conclusions: Neoadjuvant chemotherapy with the FOLFOXIRI regimen plus LLND can significantly reduce the risk of local recurrence and distant metastasis in resectable rectal cancer with LLNM, which may be a new treatment option. Clinical trial information: NCT04850027 . Variable, n (%) Total pCR (ypT0N0), n (%) 6 (11.3%) Total LNs harvested Median (IQR) 30 (24~40) LLNs harvested Median (IQR) 12 (8~17) Pathological T category ypTis 1 (1.9%) ypT0 6 (11.3%) ypT1 2 (3.8%) ypT2 11 (20.8%) ypT3 31 (58.5%) ypT4 2 (3.8%) Pathological N category ypN0 30 (56.6%) ypN1 15 (28.3%) ypN2 8 (15.1%) Pathological stage 0 6 (11.3%) I 10 (18.9%) II 17 (32.1%) III 20 (37.7%) Tumor regression grade* 0 1 (1.9%) 1 21 (39.6%) 2 12 (22.6%) 3 12 (22.6%) 4 5 (9.4%) Pathological LLN status Positive 12 (22.6%) Negative 41 (77.4%) Histologic grade Moderate 42 (79.2%) Poor/Mucinous/signet 11 (20.8%) Blood vessel invasion Yes 11 (20.8%) No 42 (79.2%) Perinervous invasion Yes 12 (22.6%) No 41 (77.4%)

Higher mammographic density (MD), a radiological measure of the proportion of fibroglandular tissue in the breast, and lower terminal duct lobular unit (TDLU) involution, a histological measure of the amount of epithelial tissue in the breast, are independent breast cancer risk factors. Previous studies among predominantly white women have associated reduced TDLU involution with higher MD. In this cohort of 611 invasive breast cancer patients (ages 23–91 years [58.4

Background: Studies investigating associations between mammographic density (MD) and breast cancer subtypes have generated mixed results. We previously showed that having extremely dense breasts was associated with the human epidermal growth factor receptor-2 (HER2)-enriched subtype in Chinese breast cancer patients. Methods: In this study, we reevaluated the MD-subtype association in 1549 Chinese breast cancer patients, using VolparaDensity software to obtain quantitative MD measures. All statistical tests were 2-sided. Results: Compared with women with luminal A tumors, women with luminal B/HER2- (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.04 to 1.38; P = .01), luminal B/HER2+ (OR = 1.22, 95% CI = 1.03 to 1.46; P = .03), and HER2-enriched tumors (OR = 1.30, 95% CI = 1.06 to 1.59; P = .01) had higher fibroglandular dense volume. These associations were stronger in patients with smaller tumors (<2 cm). In contrast, the triple-negative subtype was associated with lower nondense volume (OR = 0.82, 95% CI = 0.68 to 0.99; P = .04), and the association was only seen among older women (age 50 years or older). Conclusion: Although biological mechanisms remain to be investigated, the associations for the HER2-enriched and luminal B subtypes with increasing MD may partially explain the higher prevalence of luminal B and HER2+ breast cancers previously reported in Asian women.

目的 探讨 MRI对乳腺 X线摄影检出的恶性微钙化的敏感性及影响因素.方法 回顾性分析 X线表现为微钙化且手术病理证实为乳腺癌的 80 例患者,术前均行 MRI检查.分析 MRI的敏感性及相关影响因素.结果 共 83 个病灶,导管内癌 45个,浸润性癌 3 8 个.X线上表现为 6 7 个单纯钙化,1 6 个伴局部密度增高.MRI 的敏感性为 8 6.7％(72/83).MRI 对簇状分布钙化灶的敏感性低于其他分布方式钙化灶,但无显著差异(77.1％与 93.8％,P＝0.061).中度或明显背景强化组 MRI 的敏感性显著低于轻度或极轻微背景强化组(71.0％与96.2％,P＝0.03).对于浸润性癌,Ki-67 低表达组MRI的敏感性显著低于高表达组(75％与 100％,P＝0.026).结论 MRI对恶性微钙化诊断的敏感性为 86.7％.微钙化的 Ki-67 表达情况及乳腺的背景强化可能影响MRI诊断的敏感性.

Abstract High mammographic density (MD) is a strong risk factor for breast cancer; however, data on the association between MD and breast cancer subtypes has been inconsistent and most studies have been conducted using data from Western women. Studies have shown that Asian women, who in general have denser breasts compared with Western women, were more likely to develop luminal B and HER2-enriched tumors. We previously reported that higher MD, assessed using Breast Imaging Reporting and Data System (BI-RADS) categories, was associated with HER2-enriched tumors among Chinese breast cancer patients, which may at least partially explain the higher incidence of HER2-enriched tumors observed in Asian women. Since BI-RADS MD measurement is categorical and known to be subjective, in this study, we aimed to re-evaluate the MD-subtype association using an automated quantitative density metric. The analysis included 1,549 women with invasive breast cancer who were diagnosed and treated in a tertiary hospital in Beijing, China. Subtypes were defined as Luminal A (n=606): ER+ and PR+, HER2-, and low Ki-67 (<30% positive staining)/grade (grades 1 or 2); luminal B/HER2- (n=446): ER+ and/or PR+, HER2-, and high Ki-67 (≥30%)/grade (grade 3); luminal B/HER2+ (n=182): ER+ and/or PR+, HER2+ (regardless of Ki-67/grade); HER2-enriched (n=121): ER-, PR-, and HER2+; Triple-negative (TN, n=194): ER-, PR-, and HER2-. Quantitative measures of MD for the contralateral unaffected breast, including total breast volume, fibroglandular volume, and Volpara Density Grade (VDG, based on predetermined cut-points from volumetric percent density that shows moderate agreement with visual BI-RADS categories), were obtained using VolparaDensity software. Polychotomous logistic regression was used to assess the association between MD (per 1-unit standard deviation increase) and breast cancer subtypes with the adjustment of age, menopausal status, parity, and body mass index (BMI). Compared with luminal A cases, cases with luminal B/HER2- (Odds ratio [OR], 1.15; 95% confidence interval [CI], 1.01-1.32; p=0.04), luminal B/HER2+ (OR, 1.22; 95% CI, 1.02-1.44; p=0.03), and HER2-enriched (OR, 1.32; 95% CI, 1.08-1.60; p=0.01) tumors had significantly higher fibroglandular dense volume, and these associations were stronger in women with normal BMI. In contrast, cases with TN tumors had lower non-dense volume compared with luminal A cases (OR, 0.83; 95% CI, 0.69-1.00; p=0.05). Percent density did not vary significantly by subtypes. When comparing dense versus non-dense breasts using VDG, we found that dense breasts were significantly associated with HER2-enriched tumors (OR, 2.49; 95% CI, 1.40-4.42; p=0.002). Our data suggest that increasing dense volume was associated with luminal B and HER2-enriched subtypes among Chinese breast cancer cases. These results may provide insight into the distinct distribution of breast cancer subtypes in Asian populations. Citation Format: Xiaohong R Yang, Yuan Tian, Jennifer Guida, Hela Koka, Ariane Chan, Changyuan Guo, Erni Li, Eric Tang, Hyuna Sung, Ning Lu, Nan Hu, Gretchen Gierach, Jing Li. Association between quantitative mammographic density and breast cancer subtypes among Chinese breast cancer patients [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 P5-08-20.

Mammographic density (MD) is a strong risk factor for breast cancer, yet its relationship with tumor characteristics is not well established, particularly in Asian populations. MD was assessed from a total of 2001 Chinese breast cancer patients using Breast Imaging Reporting and Data System (BI-RADS) categories. Molecular subtypes were defined using immunohistochemical status on ER, PR, HER2, and Ki-67, as well as tumor grade. Multinomial logistic regression was used to test associations between MD and molecular subtype (luminal A = reference) adjusting for age, body mass index (BMI), menopausal status, parity, and nodal status. The mean age at diagnosis was 51.7 years (SD = 10.7) and the average BMI was 24.7 kg/m2 (SD = 3.8). The distribution of BI-RADS categories was 7.4% A = almost entirely fat, 24.2% B = scattered fibroglandular dense, 49.4% C = heterogeneously dense, and 19.0% D = extremely dense. Compared to women with BI-RADS = A/B, women with BI-RADS = D were more likely to have HER2-enriched tumors (OR = 1.81, 95% CI 1.08–3.06, p = 0.03), regardless of menopausal status. The association was only observed in women with normal (< 25 kg/m2) BMI (OR = 2.43, 95% CI 1.24–4.76, p < 0.01), but not among overweight/obese women (OR: 0.98, 95% CI 0.38–2.52, p = 0.96). Among Chinese women with normal BMI, higher breast density was associated with HER2-enriched tumors. The results may partially explain the higher proportion of HER2+ tumors previously reported in Asian women.

目的:探讨乳腺X线摄影检出的恶性微钙化病变在MR上的影像表现.方法:回顾性分析乳腺X线摄影上表现为微钙化且手术病理证实为乳腺癌的80例患者资料,均行乳腺MR检查及X线引导下金属丝定位.分析其X线、MR表现及两者的关系.统计学采用卡方检验或Fisher's精确检验.结果:共83个病灶,导管内癌45个,浸润性癌38个.X线表现:67个为单纯钙化,16个钙化伴局部密度增高;细小多形性(49个)及簇状分布(35个)是最常见的钙化形态及分布方式.MR表现:非肿块样强化57个,肿块样强化16个,未见异常强化10个.92.9％ (26/28)的段样分布钙化MR上表现为段样分布强化.段样分布钙化灶在MR上以段样分布强化更常见(P=0.000).81.3％(13/16)的肿块样强化见于簇状分布钙化.肿块样强化更多见于簇状分布的钙化灶(P=0.000).MR上假阴性钙化灶多见于簇状分布钙化灶,但没有显著差异(P=0.061).结论:恶性微钙化在MR上的强化类型以非肿块样强化常见,少部分表现为肿块样强化.其强化表现与钙化在X线上的分布方式有关.

OBJECTIVE:To retrospectively explore correlation of the resected specimen volume of breast microcalcification lesions and endogenous and exogenous factors of stereotactic needle localization biopsy (SNLB). MATERIALS AND METHODS:Totally 214 patients underwent SNLB for non-palpable breast lesion with microcalcification lesions. Of 211 patients, 198 patients underwent single needle localization and 13 patients underwent multi-needle localization (26 lesions). Lesion sizes, distribution characteristics, lesion localization accuracy and resected specimen volumes were recorded and analyzed using a generalized linear model (GLM). RESULTS:The average lesion diameter is 2.63±1.73 cm. The localization accuracy of 187 lesions were moderate, 26 were too deep and 11 were too superficial. The mean resected specimen volume (V) was 17.51±5.14 cm3. One-way ANOVA analysis showed that 3 factors, including lesion sizes, distribution characteristics and the localization accuracy were associated with resected specimen volume (F = 67.56–112.78, P < 0.001). GLM revealed that lesion sizes, single clustered distribution and accurate localization were significant factors for resected specimen volume (F = –4.82–11.36, P < 0.05). The ratio (%) of the resected specimen volume to the involved breast volume (V0) was defined as the degree of breast defect. The mean breast defect of 125 benign patients (V/V0) was 27.5% ranging from 10.1% to 42.3%. CONCLUSION:Average lesion diameter and localization accuracy are highly significant variables for the resected specimen volume. Localization accuracy as a subjective controllable variable is one of the important factors that determine the volume of lesion resection. Single clustered distribution was more susceptible localization accuracy than other characteristic distributions. Improving localization accuracy can reduce resected specimen volume, which can reduce breast defect to a certain extent.

Extensive mammographic density (MD), a well-established breast cancer risk factor, is a radiological representation of stromal and epithelial breast tissue content. In studies conducted predominantly among Caucasian women, histologic measures of reduced terminal duct lobular unit (TDLU) involution have been correlated with extensive MD, but independently associated with breast cancer risk. We therefore examined associations between TDLU measures and MD among Chinese women, a low-risk population but with high prevalence of dense breasts. Diagnostic pre-treatment digital mammograms were obtained from 144 breast cancer cases at a tertiary hospital in Beijing and scored using the Breast Imaging Reporting and Data System (BI-RADS) density classification. TDLU features were assessed using three standardized measures (count/100 mm2 , span [μm], and acini count/TDLU) in benign tissues. Associations between each of TDLU measures and MD were examined using generalized linear models for TDLU count and span and polytomous logistic regression for acini count with adjustment for potential confounders stratified by age. Among women ≥50 years, 63% had dense breasts; cases with dense breasts (BI-RADS, c-d) had greater TDLU count (21.1 [SE = 2.70] vs. 9.0 [SE = 1.83]; p = 0.0004), longer span (480.6 μm [SE = 24.6] vs. 393.8 μm [SE = 31.8]; p = 0.03), and greater acini count (ORtrend = 16.1; 95%CI = 4.08-63.1; ptrend < 0.0001) compared to those with non-dense breasts (BI-RADS, a-b). Among women <50 years, 91% had dense breasts, precluding our ability to detect associations. Our findings are consistent with previously reported associations between extensive MD and reduced TDLU involution, supporting the hypothesis that breast cancer risk associated with extensive MD may be related to the amount of "at-risk" epithelium.

BACKGROUND As one effective treatment for lateral pelvic lymph node (LPLN) metastasis (LPNM), laparoscopic LPLN dissection (LPND) is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery. With regard to improving the accuracy and completeness of LPND as well as safety, we tried an innovative method using indocyanine green (ICG) visualized with a near-infrared (NIR) camera system to guide the detection of LPLNs in patients with middle-low rectal cancer. AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer. METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision (TME) and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were compared and analysed between the two groups. RESULTS Compared to the non-ICG group, the ICG group had significantly lower intraoperative blood loss (55.8 +/- 37.5 mL vs 108.0 +/- 52.7 mL, P = 0.003) and a significantly larger number of LPLNs harvested (11.5 +/- 5.9 vs 7.1 +/- 4.8, P = 0.017). The LPLNs of two patients in the non-IVG group were residual during LPND. In addition, no significant difference was found in terms of LPND, LPNM, operative time, conversion to laparotomy, preoperative complication, or hospital stay (P > 0.05). CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.

目的:探讨MRI对乳腺黏液癌与T2 WI高信号纤维腺瘤的鉴别诊断价值.方法:回顾性分析经手术或穿刺病理证实且有完整MR影像资料的乳腺黏液癌69例和T2 WI高信号纤维腺瘤76例,分别对病灶最大径、形态学、信号强度、DWI-ADC值、强化特点及TIC类型进行评价及测量.采用x2检验对定性资料进行比较,采用独立样本t检验或秩和检验对定量资料进行比较.结果:乳腺黏液癌发病中位年龄高于纤维腺瘤(P＜0.001).纤维腺瘤较黏液癌双侧、多灶更多见(P=0.030).形态上黏液癌以不规则形为主,纤维腺瘤以卵圆形为主(P=0.009).黏液癌边缘不规则较纤维腺瘤多见(P=0.001).黏液癌的平均ADC值高于纤维腺瘤,分别为(1.99±0.33)×10-3 mm2/s和(1.60±0.27)×10-3mm2/s(P＜0.001).乳腺黏液癌增强早期易出现边缘强化,强化可逐渐向中心充填,延迟期呈不均匀或边缘强化;纤维腺瘤增强早期强化明显、多不均匀,延迟期强化趋于均匀一致.TIC类型黏液癌多为流入型,纤维腺瘤多为平台型(P＜0.001).结论:结合形态学、DWI-ADC值及MR强化特征,乳腺黏液癌与T2 WI高信号纤维腺瘤具有较高的鉴别诊断价值.

目的 探讨年轻乳腺癌患者的心理健康状况以及心理需求,为制定临床决策,给予患者社会支持,开展关怀计划提供参考.方法 选取于我院就诊的年龄小于35岁的乳腺疾病患者74例,经病理证实50例恶性患者为研究组,24例良性者为对照组.采用艾森克人格量表、焦虑和抑郁评价量表评测患者的心理健康状态,通过心理需求调查表,对患者关注的心理需求实施调查,并采用社会支持评定量表调查患者的社会支持利用程度.调查方法采用面谈和电话回访.记录并统计分析得分.结果 年轻乳腺癌患者存在明显的焦虑、抑郁状态及神经质倾向(t1=5.439,t2=1.454,t73.758,P＜0.05).心理需求主要集中在治疗费用、乳房缺损补救、婚姻生活质量以及生育能力方面,其中88％患者有生育计划,而患者生育知识回答正确率仅为8.6％～42.9％.两组患者社会支持利用度得分均较低,且二者比较差异无统计学意义(t=-0.798,P＞0.05).结论 年轻乳腺癌群体存在着明显的紧张、焦虑、易怒等神经质倾向应给与患者专业的心理疏导.应高度重视青年乳腺癌患者的心理需求,增加针对性的生育知识宣传,给予有效支持与帮助,及时调整治疗决策.同时,年轻乳腺癌患者对社会支持的利用程度明显不足,应增加渠道、创新方式,优化社会支持网络.

Terminal duct lobular unit (TDLU) involution is a physiological process of breast tissue aging characterized by a reduction in the epithelial component. In studies of women with benign breast disease, researchers have found that age-matched women with lower levels of TDLU involution are at increased risk of developing breast cancer. We previously showed that breast cancer cases with core basal phenotype (CBP; estrogen receptor negative [ER−], progesterone receptor-negative [PR−], human epidermal growth factor receptor 2-negative [HER2−], cytokeratins (CK 5 or CK5/6)-positive [CK5/6+] and/or epidermal growth factor receptor-positive [EGFR+]) tumors had significantly reduced TDLU involution compared with cases with luminal A (ER+ and/or PR+, HER2−, CK5/6−, EGFR−) tumors from a population-based case-control study in Poland. We evaluated the association of TDLU involution with tumor subtypes in an independent population of women in China, where the breast cancer incidence rate, prevalence of known risk factors, and mammographic breast density are thought to be markedly different from those of Polish women.

Abstract Introduction: Terminal duct lobular unit (TDLU) involution, an age-related physiological process, is characterized by the reduction of size and numbers. Reduced involution is associated with higher mammographic density, a strong breast cancer risk factor. Both factors predict risk of developing breast cancer among women with benign disease. Given that prior studies have been conducted mainly in White women, we compared the extent of TDLU involution among Western and Asian breast cancer cases to describe potential racial heterogeneity in breast cancer etiology. Method: We obtained three TDLU involution metrics (count/100 mm2, mean span, and mean acini count/TDLU; all inversely correlated with TDLU involution) measured in benign breast tissue sections from 379 Chinese (254 luminal A and 125 core basal phenotype [CBP] cases) and 476 Polish (407 luminal A and 69 CBP) breast cancer cases. Polytomous logistic regression was performed using tertiles of TDLU measures as ordinal dependent variable and race as an independent variable. Covariates included age, body mass index, and parity. Analyses were performed separately by age group (<50, ≥50) and subtype (luminal A and CBP). Results: Among luminal A cases, Chinese had significantly greater TDLU count compared with Polish in both age groups (ORtrend= 11.0; 95% CI=2.80-43.2; Ptrend=0.001 for age<50; ORtrend= 12.1; 95% CI=5.12-28.7; Ptrend=1E-08 for age≥50). In addition, Chinese were more likely to have greater mean span and acini count among younger cases (ORtrend=2.5; 95% CI=1.44-4.28; Ptrend=0.001 for mean span and ORtrend=7.4; 95% CI=4.13-13.4; Ptrend=3E-11 for acini count) but not among older cases. Among CBP cases, Chinese were more likely to have greater acini count compared to Polish only among younger women (ORtrend=2.6; 95% CI=1.12-6.95; Ptrend=0.03 for age<50). Conclusion: We found Chinese were more likely to have reduced TDLU involution compared to Polish cases after accounting for potential confounders, with greater differences for luminal A and younger women. Studies of TDLU involution in diverse populations are needed to confirm and understand whether population difference in TDLU involution metrics are related to age at breast cancer onset and risks for specific tumor subtypes. Citation Format: Hyuna Sung, Changyuan Guo, Jennifer Guida, Shan Zheng, Erni Li, Jing Li, Nan Hu, Joseph Deng, Montserrat Garcia-Closas, Jonine Figueroa, Mark Sherman, Gretchen Gierach, Ning Lu, Xiaohong R. Yang. Racial variation in terminal duct lobular unit (TDLU) involution in Chinese and Polish breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5290. doi:10.1158/1538-7445.AM2017-5290

Objective To evaluate MRI breast imaging report and data system( BI-RADS) in diagnosing and differentiating breast lesions presenting as non-mass enhancement( NME). Methods A total of 203 patients with NME breast lesion,who had received MRI examination during the period from October 2010 to January 2013,were enrolled in this study.The diagnosis was confirmed by pathology or by clinical following-up for more than one year. Based on BI-RADS classification,the dynamic enhancement morphologic features and the time-intensity curve( TIC) were analyzed; the lesions were classified,and the findings were compared with pathological results. Results A total of 209 lesions were detected in the203 patients,including 58 benign lesions( 27. 75%) and 151 malignant lesions( 72. 25%). In the benign lesions,adenosis was most often seen( 15 /58,25. 86%); while in the malignant lesions,invasive ductal carcinoma was most commonly observed( 72 /151,47. 68%),containing the component of ductal carcinoma in situ in all patients. Statistically significant differences in focal distribution,segmental distribution and cluster ring enhancement existed between the benign and malignant lesions( P = 0. 001,P = 0. 003 and P = 0. 010 respectively). The differences in TIC type Ⅰ and type Ⅲ between the benign and malignant lesions were statistically significant( P = 0. 000 and P = 0. 018 respectively). The risk factors of the malignant lesions included segmental distribution,cluster ring enhancement and TIC type Ⅲ( OR = 3. 5,OR = 4. 22 and OR = 2. 48 respectively). The sensitivity,specificity and accuracy of MRI BI-RADS for the diagnosis of malignant NME lesions were 94. 04%,55. 17%,and 83. 25% respectively. Conclusion MRI BI-RADS is an effective method for the diagnosis and differentiation of malignant and benign NME lesions. This method carries higher sensitivity and accuracy,although its specificity is lower.

Objective:To evaluate the MRI appearance of phyllodes breast tumors and to differentiate them from ifbroadenomas. Materials and Methods:MR images were obtained on GE medical system 3.0-T imager. MR images of 23 patients with 24 phyllodes breast tumors proved by surgery or biopsy pathology were retrospectively analyzed. The results were compared with the MRI appearance of 62 ifbroadenomas of 59 patients by using Chi-square test Fisher’s Exact test and t test. Results:There is statistical difference (P=0.004) in average maximum diameter between phyllodes breast tumor and ifbroadenomas. Still, there is another statistical difference (P<0.05) in tumor shape and edge between the both. Phyllodes tumors show as lobulated shape commonly (12/24, 50.00%) or irregular shape sometimes (2/24, 8.33%), while ifbroadenomas show as quasi-circular shape (29/62, 46.77%) or lobulated shape (27/62, 43.55%) commonly and no irregular shape seen. In the aspects of tumor edge, most ifbroadenomas show smoothly (58/62, 93.55%) and less irregular edge. On the contrary, phyllodes tumors have more irregular edges (7 tumors with irregular edges (29.17%) and 1 tumor with spiculation). Meanwhile, 11 (11/24, 45.83%) phyllodes tumors show patchy hyperintense (bleeding tip) on T1WI compared with ifbroadenomas, which has no this kind of signal. On T2WI fat saturation, it shows statistical difference (P=0.025) that phyllodes tumors have hyperintense mostly (21/24, 87.5%) with no isointense or hypointense and fibroadenomas have isointense, hypointense and mixed signal as well as hyperintense (43/62, 69.35%). Furthermore, cystic change area is to be seen in 8 (8/24, 33.33%) phyllodes tumors and no this kind of area in ifbroadenomas. In terms of enhanced low signal lace and no-enhanced one, both tumors have not evidently statistical difference. Regarding of curve characteristic, the statistical difference (P=0.008) has showed that II type and III type is mostly seen in phyllodes tumors I type is seen at most in ifbroadenomas. Finally, there is no evidently statistical difference (P=0.068) of average ADC between both tumors. Conclusions:There are differences between the phyllodes breast tumors and ifbroadenomas on MRI performance. Several DCE-MR ifndings can be used to help differentiation of phyllodes breast tumors from ifbroadenomas.