Background:Accurate pre-treatment identification of patients likely to achieve axillary pathologic complete response (pCR) after neoadjuvant therapy (NAT) is important for individualized axillary management in initially node-positive breast cancer. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may capture intratumoral and peritumoral heterogeneity associated with treatment sensitivity, but its value for predicting axillary response remains unclear. Therefore, this study aimed to develop and validate a pretreatment DCE-MRI-based radiomics model for predicting axillary pCR after NAT in initially node-positive breast cancer. Methods:In this retrospective study, pretreatment MRI scans were acquired in patients with initially axillary lymph node (ALN)-positive breast cancer who underwent NAT followed by surgery between January 2017 and December 2019. Patients were randomly assigned to primary and validation cohorts at a ratio of 8:2. Radiomics features were extracted from intratumoral and 3-mm peritumoral regions across one precontrast and five postcontrast DCE-MRI phases. The variances of each feature across the six DCE-MRI phases were calculated and used to construct a radiomics signature in the primary cohort. ALN pCR was defined as the absence of micrometastasis and macrometastasis in ALNs on postoperative histopathology. Univariate analyses and multivariate logistic regression analyses were used to identify predictors of ALN pCR. Clinical, radiomics, and combined models were developed based on the independent predictors, and evaluated in the validation cohort. Results:A total of 175 women were included (mean age ± standard deviation, 47.83±10.39 years), of whom 58 achieved axillary pCR. Initial clinical N stage, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, perinodal infiltration, and radiomics score (R-score) were independent predictors of ALN pCR. The combined model showed the best predictive performance, with area under the curves (AUCs) of 0.90 [95% confidence interval (CI): 0.84-0.96] and 0.87 (95% CI: 0.75-0.99) in the primary and validation cohorts, respectively. In the validation cohort, the combined model achieved a sensitivity of 78.6% and a specificity of 85.7%. Conclusions:A pretreatment DCE-MRI-based combined model integrating radiomics and clinicopathologic factors showed promising performance for predicting axillary pCR after NAT in initially ALN-positive breast cancer. This model may support pretreatment risk stratification of axillary response, but external validation is required before clinical application.

To determine whether wash-in slope (WIS) changes can predict pathologic complete response (pCR) following NAC in breast cancer. This single-center retrospective study included consecutive females with breast cancer who received NAC followed by surgery between January 2016 and December 2022. All patients received dynamic contrast-enhanced MRI (DCE-MRI) pretreatment, after 2 cycles, 4 cycles, and after completion of treatment. The percentage change in tumor WIS from that before treatment (ΔWIS) was measured at each time point. Predictive performance for pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and across molecular subtypes. A total of 162 patients were included in this study (mean age, 51.9 years ± 9.1 [SD]), and 43 (26.5

Background: Among human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients who receive anti-HER2 treatment, a noteworthy correlation between pathological complete response (pCR) and longer survival has been observed. The rate of pCR varies with the tumor's degree of HER2 protein expression. The aim of this study was to assess the correlations between clinicopathological characteristics, magnetic resonance imaging (MRI) parameters, and pCR in breast cancer with different HER2 subcategories. Methods: A total of 281 invasive breast cancer patients diagnosed with HER2-positivity were included. HER2-positive translated to immunohistochemistry (IHC) 3+ or IHC 2+/fluorescence in situ hybridization (FISH)(+). All enrolled patients underwent baseline MRI examination and received neoadjuvant chemotherapy, dual anti-HER2 therapy, and subsequent therapeutic surgery from January 2021 to May 2022. A logistic regression model was used to evaluate the effects of covariates on pCR. Results: Compared to the IHC 2+/FISH(+) group, patients with IHC 3+ tumors had a higher pCR rate (58.1% vs. 26.7%, P<0.001), clinical stage (58.6% vs. 40%, P=0.038), apparent diffusion coefficient (ADC) value (0.96 vs. 0.88 mm2/s, 2 /s, P=0.004), and were more likely to be estrogen receptor (ER) negative (55.9% vs. 31.1%, P=0.002) and progesterone receptor (PR) negative (72.5% vs. 46.7%, P=0.001). In both groups, univariate analysis showed that the pCR group more often had ER-negative and PR-negative status than the non-pCR group (P<0.001). The final multivariable analysis showed that ER-negativity was associated with pCR in the IHC 2+/FISH(+) group (P=0.004). ER-negativity and the longest diameter were two independent predictors of pCR in the IHC 3+ group (P<0.001 for ER, P=0.026 for longest diameter). Conclusions: The IHC 3+ group had a higher pCR rate than the IHC 2+/FISH(+) group. Along with clinicopathological characteristics, MRI parameters were supplemental predictors of pCR, particularly in IHC 3+ patients.

Background: Shear wave elastography (SWE) can improve the specificity of B-mode ultrasound (US) without reducing the sensitivity for breast cancer diagnosis. Existing research on SWE includes both mass lesions and non-mass-like (NML) lesions or only NML lesions; however, there are no studies comparing the diagnostic po-tential of SWE in the detection of mass and NML lesions in the same trial.Objective: This study aimed to compare the diagnostic performance of SWE in detecting mass lesions and NML lesions and determine the different individualised thresholds of the SWE parameters according to the lesion type. Methods: This Study included 623 breast lesions of 562 consecutive women, who were scheduled for conventional US and SWE between January 2021 and December 2021. The diagnostic performances of conventional US and each quantitative SWE parameter (maximum elastic modulus [Emax], mean elastic modulus [Emean], and elastic modulus standard deviation [Esd]) were assessed. Histological diagnosis for all Breast Imaging Reporting and Database System (BI-RADS) category 4/5 patients and some BI-RADS category 3 patients and the follow-up results of other BI-RADS category 3 patients were used as the reference standard.Results: In this study, 281 benign lesions and 342 malignant lesions were identified. The diagnostic performance of conventional US and SWE was better in the mass lesion group than in the NML lesion group. Every SWE parameter had a different threshold in each group, and the thresholds of the SWE parameters were higher in the mass lesion group than in the NML lesion group. In the mass lesion group, Esd had the highest Az value, whereas in the NML lesion group, Emax had the highest Az value. In both the mass and NML lesion groups, the diagnostic specificity of the combination of conventional US and SWE was significantly higher than that of conventional US alone (P < 0.05), without a significantly decrease in the diagnostic sensitivity.Conclusions: SWE could increase the confidence of breast ultrasound diagnosis, especially for NML lesions. NML lesions had lower thresholds of SWE parameters than did the mass lesions.

Purpose To explore the correlation between shear-wave elastography (SWE) parameters and pathological profiles of invasive breast cancer. Methods A total of 197 invasive breast cancers undergoing preoperative SWE and primary surgical treatment were included. Maximum elastic modulus (Emax), mean elastic modulus (Emean), and elastic modulus standard deviation (Esd) were calculated by SWE. Pathological profile was gold standard according to postoperative pathology. The relationship between SWE parameters and pathological factors were analyzed using univariate and multivariate analysis. Results In univariate analysis, large cancers showed significantly higher Emax, Emean and Esd (all P < 0.001). Emax and Esd in the group of histological grade III were higher than those in the group of grade I (both P < 0.05). Invasive lobular carcinomas (ILC) showed higher Emean than invasive ductal carcinoma (IDC) (P < 0.001). Lymphovascular invasion (LVI) group showed higher Emax values than negative group (P < 0.05). Emax, Emean and Esd of the Ki-67 positive group presented higher values than negative group (all P < 0.05). Androgen receptor (AR) positive lesions had lower Esd than AR negative lesions (P < 0.05). In multivariate analysis, invasive size independently influenced Emax (P < 0.001). Invasive size and pathological type both independently influenced Emean (both P < 0.001). Invasive size and AR status were both independently influenced Esd (both P < 0.05). Conclusion SWE parameters correlated with pathological profiles of invasive breast cancer.In particular, AR positive group showed significantly low Esd than negative group.

To develop a nomogram based on pretreatment dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with triple-negative breast cancer (TNBC). A total of 108 female patients with TNBC treated with neoadjuvant chemotherapy followed by surgery between January 2017 and October 2020 were enrolled. The patients were randomly divided into the primary cohort (n = 87) and validation cohort (n = 21) at a ratio of 4:1. The pretreatment DCE-MRI and clinicopathological features were reviewed and recorded. Univariate analysis and multivariate logistic regression analyses were used to determine the independent predictors of pCR in the primary cohort. A nomogram was developed based on the predictors, and the predictive performance of the nomogram was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). The validation cohort was used to test the predictive model. Tumor volume measured on DCE-MRI, time to peak (TTP), and androgen receptor (AR) status were identified as independent predictors of pCR. The AUCs of the nomogram were 0.84 (95% CI: 0.75–0.93) and 0.79 (95% CI: 0.59–0.99) in the primary cohort and validation cohort, respectively. Pretreatment DCE-MRI could predict pCR after NAC in patients with TNBC. The nomogram can be used to predict the probability of pCR and may help individualize treatment. • Pretreatment DCE-MRI findings can predict pathologic complete response (pCR) after neoadjuvant chemotherapy in patients with triple-negative breast cancer. • A nomogram based on the independent predictors of tumor volume measured on DCE-MRI, time to peak, and androgen receptor status could help personalized cancer treatment in TNBC patients.

Prostate-specific membrane antigen (PSMA) is a prominent biomarker for prostate cancer (PCa) diagnosis. Safe contrast agents able to render the expression and distribution of PSMA would facilitate early accurate screening and prognostic prediction of PCa. However, current Gd-containing nanoparticles are often limited by nonspecific redistribution in mononuclear phagocyte system (MPS) and inadequate perfusion to target sites. Besides, intrinsic defects of magnetic resonance (MR) equipment also hamper their use for precisely depicting PSMA details. Herein, we devised a novel noninvasive MR/CT/NIRF multimodal contrast agent (AGGP) coordinated to a high-affinity PSMA ligand (PSMA1) to specifically detect and quantify PSMA expression in PCa lesions, which exhibited formidable tripe-modal signal augments, preferential PSMA targeting, effective MPS escaping and profitable renal-clearable behavior in living mice. Biocompatibility and histopathological studies substantiated high security of AGGP in vivo, opening the door to future opportunities for improving early-stage PCa detection and clinical implementation of more effective multifunctional nanotherapeutics.

目的:比较年龄60岁以上老年乳腺癌与60岁以下非老年乳腺癌患者的乳腺X线影像学表现并分析病灶微钙化阳性率与年龄的相关性.方法:回顾性分析2012年6月至2013年4月天津医科大学肿瘤医院1959例经病理确诊的乳腺癌患者的乳腺X线影像学资料,以60岁为界分为老年组(n=512)和非老年组(n=1447)并进行统计学分析.结果:老年组和非老年组中高密度肿块的患者分别占73.0％(330/452)和46.0％(464/1008),等/低密度肿块的患者分别占27.0％(122/452)和54.0％(544/1008),两组比较差异具有统计学意义(P<0.05).老年组和非老年组中病灶微钙化阳性率分别为34.8％(178/512)和41.7％(603/1447),两组比较差异具有统计学意义(P<0.05).1959例患者根据年龄<30岁、30～39岁、40～49岁、50～59岁、60～69岁和年龄≥70岁进行分组,病灶微钙化阳性率分别占58.8％(10/17)、42.8％(74/173)、41.0％(259/632)、41.6％(260/625)、38.2％(137/359)和26.8％(41/153),随着年龄增长病灶微钙化阳性率整体呈下降趋势,差异具有统计学意义(P=0.008).结论:老年组与非老年组乳腺X线影像学表现中的肿块密度及病灶微钙化阳性率不同,病灶微钙化阳性率呈随年龄增长而降低的趋势.

Objective To evaluate the influencing factors of mammography versus ultrasonography in detecting early stage breast cancer and epidemiological characteristics. Methods A retrospective analysis was performed on stage T1(tumor diameter≤2 cm) and Tis(ductal carcinoma in situ) breast cancer confirmed by histopathology from July 2011 to July 2013, 959 patients(971 lesions) had mammography, ultrasonography, and epidemiological data. According to the BI-RADS, the lesions of BI-RADS categories 1, 2, 3, 4A were negative, the lesions of BI-RADS categories 4B, 4C, 5 were positive. A face to face interview questionnaire collected information regarding epidemiological data, including age, body mass index, age at menarche, age at first live birth, history of pregnancy, number of live births, history of lactation, history of abortion, and menopausal status. The χ2 test was used to compare the efficacy of mammography and ultrasound in detecting early stage breast cancer. Logistic regression was used to analyze the relative factors influencing the detection rate of two modalities. Results The detection rate of mammography and ultrasound was 90.1%(875/971)and 92.6%(899/971)respectively with statistical significance(χ2=150.34, P=0.000). Breast density, lesion types, age, and postmenopausal status were risk factors for the detection rate of early stage breast cancer on mammography, the odds ratios(OR) was 0.315, 6.669, 2.609, and 2.236 and the 95%CI was 0.136—0.731, 2.841—15.658, 1.681—4.048, and 1.453—3.439, respectively. Lesion types and age were risk factors for the detection rate of early stage breast cancer on ultrasonography, the OR was 0.204, 1.798, and 95%CI was 0.103—0.405, 1.107—2.920, respectively. More than patients with less than 50 years old showed only-calcification type breast cancer on mammography(OR=2.256, 95%CI:1.348—3.773), women with lower number of live birth showed not only-calcification type breast cancer on mammography(OR=0.467,95% CI:0.250—0.872). Conclusion Breast density, age, postmenopausal status and lesion types were risk factors for epidemiological characteristics associated with detection rate of early stage breast cancer for mammography versus ultrasonography.

Objective To investigate the application value of blood-oxygen functional imaging system ( BOFIS) in di-agnosis of breast neoplasms. Methods Totally 201 patients with histopathologically verified breast lesions were selected, and the histology revealed there were 140 cases of benign lesions and 61 cases of malignancies. BOFIS, ultrasound and mammography were respectively used on these patients. The sensitivity, specificity and accuracy of BOFIS, ultrasound, mammography and combined criteria were analyzed. Results The sensitivities of BOFIS, ultrasound and mammography were 77. 14%, 94. 29% and 90. 71%. The specificities were 54. 10%, 86. 89% and 83. 61%, respectively. The accura-cies were 70. 15%, 92. 04% and 88. 56%, respectively. Significant difference was found between them (P<0. 05). The combination with BOFIS can improve the diagnostic sensitivity of ultrasound/mammography alone. Conclusions BOFIS provides a new way for the diagnosis of breast disease. After combining with the conventional examination ( ultrasound or mammography) , BOFIS improves the diagnostic sensitivity, and can be used as a beneficial supplement to the imageologi-cal examination of breast.

OBJECTIVE To compare the efficacy of mammography versus ultrasonography in detecting stages T1 and Tis breast cancer. METHODS Mammography and ultrasonograhpy data were collected for 1 630 stages T1 and Tis breast cancer from July 2011 to July 2013. Chi-square test was used to analyze the detection rate and diagnostic rate of two methods. RESULTS Among 1 630 patients with 1 665 focus, 1 559 focus were detected by both methods. In term of detection rate, mammography had a higher rate in mostly fatty and scattered fibroglandular breast while ultrasonography offered advantages in extremely dense breast. And statistical significance existed among these groups (P < 0.05). In heterogeneously dense group, the detection rate of two methods had no statistical significance (P > 0.05). In term of diagnostic rate, mammography had a higher diagnostic rate in mostly fatty and scattered fibroglandular breast. On the contrary, ultrasonography was superior to mammography in heterogeneously and extremely dense breast. No statistical significance existed among these groups (P > 0.05). Furthermore the focus were classified into mass and non-mass types based on mammographic images. As the volume of fibroglandular tissue increased, the amount of mass type focus increased while that of non-mass type focus decreased. CONCLUSION For stages T1 and Tis breast cancer, mammography has higher detection and diagnostic rates in mostly fatty and scattered fibroglandular breast while ultrasonography is better for heterogeneously and extremely dense breast. There are some correlations between fibroglandular and focus types based on mammographic images.

Objective To analyze the relationship between age,mammographic breast density and expression levels of estrogen receptor (ER) and progesterone receptor (PR) in patients with breast cancer.Methods Data of immunohistochemistry and preoperative mammography of 992 breast cancer patients confirmed by pathology were retrospectively analyzed.The mammographic density status of different age was analyzed and the relationship between age,mammographic breast density and expression levels of ER and PR were assessed.Results There were 52.92％ (525/992) patients with breast cancer having high breast density.The percentages of low breast density and high breast density were 10.26 ％ and 89.74 ％ in ＜35 years old patients,21.92％ and 78.08％ in 35-39 years old patients,22.92％ and 77.08％ in 40-44 years old patients,26.18％ and 73.82％ in 45-49 years old patients,43.04％ and 56.96％ in 50-54 years old patients,65.24％ and 34.76％ in 55-59 years old patients,83.76％ and 16.24％ in 60-64 years old patients,89.80％ and 10.20％ in 65-69 years old patients,94.12％ and 5.88％ in ＞69 years old patients.There was statistical significance of breast density between ＜55 and ≥55 years old patients (z=-16.11,P＜0.01).Age was slightly positively correlated with ER (r=0.09,P＜0.01) and slightly negatively correlated with PR (r=-0.14,P＜0.01).Breast density was slightly negatively correlated with ER (r=-0.07,P=0.02) and not statistically correlated with PR (r=0.05,P=0.13).Conclusion Age and mammographic breast density are correlated with expression level of ER and PR in patients with breast cancer,which have potential assessment value for expression of ER and PR.

Background: A dense breast not only reduces the sensitivity of mammography but also is a moderate independent risk factor for breast cancer. The percentage of Western women with fat breast tissue is higher aged 40 years or older. To a certain extent, mammography as a first choice of screening imaging method for Western women of this group is reasonable. Hitherto, the frequency and age distribution of mammographic breast density patterns among Chinese women had not been characterized. The purpose of this study was to investigate the frequency and age distribution of mammographic breast density patterns among a group of Chinese screening women and breast cancer patients in order to provide useful information for age-specific guidelines for breast cancer screening in Chinese women. Methods: A retrospective review of a total of 3,394 screening women between August and December 2009 and 2,527 breast cancer patients between July 2011 and June 2012 was conducted. Descriptive analyses were used to examine the association between age and breast density. The significance of differences of breast density between the screening women and the breast cancer patients was examined using nonparametric tests. Results: There was a significant inverse relationship between age and breast density overall (r=-0.37, p< 0.01). Breast density of the breast cancer patients in the subgroups of 40-49 years old was greater compared with that of the screening women, the same in those aged 50-54 years and in those 55 years old or older, less than in the screening group. Conclusions: With regard to the Chinese women younger than 55 years old, the diagnostic efficiency of breast cancer screening imaging examinations may be potentially improved by combining screening mammography with ultrasound.

Background: To study the relationship between mammographic findings and clinical/pathologic features in women with 1-15mm sized invasive breast cancer. Materials and Methods: We investigated a consecutive series of 134 cases diagnosed in Tianjin Medical University Cancer Institute and Hospital in 2007. Mammographic findings were classified into five groups as follows :1) stellate mass without calcification; 2) non-stellate mass without calcification; 3) intermediate suspicious calcification with or without associated mass; 4) higher probability malignant calcification with or without associated mass; 5) focal asymmetry/distortion without associated calcification. Associations between mammographic and clinical/pathological features (menopause status/family history/histologic grade/lymph node status and ER/PR/HER2 status) was analyzed through logistic regression and chi square tests. Results: Compared to the stellate mass without calcification group, higher probability malignant calcification patients were associated significantly with a positive lymph node status, always presenting in patients who were non-menopausal and with a family history of carcinoma. Conclusions: Higher probability malignant calcifications with or without associated tumor masses are associated with clinical/pathologic features of poor prognosis.

To analyze the clinicopathological features and prognosis of T1mic, a, bN0M0 breast cancer.The clinical data and survival status of 4487 cases of operable breast cancer treated in our hospital from 2002 to 2005 were collected, including 372 cases with T1mic, a, bN0M0 breast cancers. These patients were divided into four subtypes: Luminal A, Luminal B, triple-negative and human epidermal growth factor receptor 2-positive. Disease-free survival and risk factors for recurrence were identified.We identified 372 eligible patients. The median follow-up was 78 months (range: 5106 months). Univariate analysis showed age, adjuvant endocrine therapy, hormonal receptor and human epidermal growth factor receptor 2 were prognostic factors. Multivariate analysis showed that hormonal receptor and human epidermal growth factor receptor 2 were prognostic factors. In the hormonal receptor-positive group, human epidermal growth factor receptor 2-positive patients (Luminal B) had a four times higher recurrence risk than human epidermal growth factor receptor 2 negative (Luminal A) patients. However, there was no statistically significant difference between hormonal receptor-negative groups (triple-negative and human epidermal growth factor receptor 2-positive).Hormonal receptor and human epidermal growth factor receptor 2 were independent factors of 5-year disease-free survival for patients with T1mic, a, bN0M0 breast cancer. The Luminal B group had a worse prognosis than the Luminal A group, but there was no statistically significant difference between triple-negative and human epidermal growth factor receptor 2-positive groups.

Objective: To analyze the clinicopathological features and prognosis of patients with T1micN0M0, T1aN0M0 and T1bN0M0 breast cancer, and to evaluate the survival and independent prognostic factors. Methods: The clinicopathological data from 4 487 patients who could receive surgical operation between January 2002 and December 2005 were collected. The clinicopathological features, recurrence, metastasis and survival of 376 patients with T1micN0M0, T1aN0M0 and T1bN0M0 breast cancer were retrospectively analyzed. Results: Three hundred and seventy-six eligible patients were identified. Of these 376 patients, 66 patients (17.6%) had T1mic breast cancer (pT≤0.1 cm), 122 patients (32.4%) had T1mic breast cancer (0.1 cm＜pT≤0.5 cm), and 188 patients (50.0%) had T1b breast cancer (0.5 cm＜pT≤1.0 cm). With the lager tumor size, the histology grade was higher, the positive rate of estrogen receptor was lower, and the incidence of adjuvant chemotherapy was higher (P＜0.05). Univariate analysis showed that the age, hormone receptor and HER-2 status were prognostic factors for 5-year disease-free survival. Multivariate analysis showed that the hormone receptor and HER-2 were prognostic factors for 5-year disease-free survival. The 5-year recurrence risk in the positive hormone receptor group was four times as high as that in the negative hormone receptor group (hazard ratio was 4.995, 95% confidence interval was 1.113-22.424). In negative hormone receptor group, there was no statistically significant difference in the risk of 5-year recurrence between patients with positive HER-2 and negative HER-2 (hazard ratio was 2.757, 95% confidence interval was 0.849-8.955). Conclusion: HR and HER-2 status were independent prognostic factors for 5-year DFS in T1micN0M0, T1aN0M0 and T1bN0M0 breast cancer. Hormone receptor positive disease with positive HER-2 status was associated with a high risk of cancer recurrence. DOI:10.3781/j.issn.1000-7431.2011.11.012

目的:分析T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者的临床病理学特征,了解其生存状态,探讨与预后相关的独立影响因素.方法:收集2002年1月-2005年12月4 487例可手术的乳腺癌患者的临床病理学资料,回顾性分析其中376例T1micN0M0、T1N0M0和T1bN0M0患者的临床病理学特征、复发和转移以及生存情况.结果:376例患者中,66例(17.6％)为T1mic (pT≤0.1 cm),122例(32.4％)为T1a(0.1 cm＜pT≤0.5 cm),188例(50.0％)为T1b (0.5 cm＜pT≤1.0 cm).肿瘤直径越大,其组织学分级越高、雌激素受体阳性率越低、辅助化疗率越高(P＜0.05).单因素分析显示,年龄、激素受体和HER-2状态是5年无病生存的影响因素.多因素分析显示,HR和HER-2状态是5年无病生存的独立影响因素.HR阳性组中,HER-2阳性患者的5年复发风险是阴性组的约4倍(风险比为4.995,95％可信区间为1.113～22.424);HR阴性组中,HER-2阳性与阴性患者的差异无统计学意义(风险比为2.757,95％可信区间为0.849～8.955).结论:HR和HER-2状态是T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者5年无病生存的独立影响因素.HR阳性时,HER-2阳性患者的复发风险较高.