1. The study examined changes in background parenchymal enhancement (BPE) on breast MRI scans of 73 patients before and after neoadjuvant chemotherapy (NAC) to see if it correlated with tumor response.
2. BPE decreased in over half of patients after NAC, with a greater decrease seen in premenopausal patients. Higher decreases in BPE correlated with better tumor responses to chemotherapy.
3. While initial BPE levels did not predict response, the degree of BPE decrease after NAC, especially in patients with a complete response, provides a potential predictor of tumor response to chemotherapy.
Triple Negative Breast Cancer and Women of Color (Slide 2)bkling
In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month
Oncologist briefing given by Dr. Castel as Principal Investigator of the Breast Cancer Adjuvant Therapy prospective longitudinal study (NCT00954564) to communicate interim results and help oncologists identify and refer eligible breast cancer patients into the longitudinal cohort study. The goal of this presentation was to help achieve study enrollment targets.
Triple Negative Breast Cancer and Women of Color (Slide 2)bkling
In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month
Oncologist briefing given by Dr. Castel as Principal Investigator of the Breast Cancer Adjuvant Therapy prospective longitudinal study (NCT00954564) to communicate interim results and help oncologists identify and refer eligible breast cancer patients into the longitudinal cohort study. The goal of this presentation was to help achieve study enrollment targets.
The information in this slide show is the intellectual property of James Waisman, M.D. Written permission is required to use content found in this document.
Physical Therapy is an integral part of breast cancer rehabilitation. Those undergoing treatments for breast cancer often face surgery. Physical therapists can work with women to alleviate symptoms caused by surgical intervention or medical treatment for cancer. The Prospective Surveillance Model, or PSM, is a proactive approach to periodically examining patients and providing continued assessment during and after disease treatment, often in the absence of impairment.
Learn about the latest research and treatment for ER+ breast cancer. Erica Mayer, MD, MPH, medical oncologist with the Susan F. Smith Center for Women's Cancers, discusses new clinical trials and treatment options for this subset of breast cancer patient.
This presentation was originally given on Oct. 17, 2015, at the Metastatic Breast Cancer Forum, hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Triple Negative Breast Cancer and Women of Color (Slide 1)bkling
In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month.
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Join Dr. Erica Mayer, medical oncologist at Dana-Farber/Brigham and Women's Cancer Center, to learn about exciting metastatic breast cancer developments from the past year. Dr. Mayer presents an overview on metastatic breast cancer and the subgroups, including Hormone Receptive, HER2+, and Triple Negative, and highlights recent advances for each of these subgroups. She also discusses the importance of clinical trials and what it means to participate in a clinical trial.
For more information on the Breast Cancer Treatment Center at Dana-Farber Cancer Institute, please visit:
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Treatment-Centers-and-Clinical-Services/Breast-Cancer-Treatment-Center.aspx
New Predictors for Periampullary Resectabilityasclepiuspdfs
Background: Periampullary tumor involves ampullary, pancreatic, biliary and duodenal mucosa, and pancreaticoduodenectomy considered the curative option. Hence, imaging evaluation to describe the lesion is important. Furthermore, certain specific features could help in pre-operative prediction of resectability for periampullary cancers. The aim of this study is to find out any specific perioperative predictor of resectability on periampullary cancers. Patients and Methods: This is an observational cross-sectional hospital-based study done in tertiary hospital, a total of 79 patients were included in the study. Variables such as age, gender, symptoms (back pain, jaundice, etc.), investigations (bilirubin, alkaline phosphatase, etc.), and imaging (Triphasic computed tomography [CT], magnetic resonance cholangiopancreatography, endoscopic ultrasonography, etc.) were studied and the data collected and analyzed using SPSS 20. Results: Male was slightly predominant and male to female ratio was 1:0.9. The mean age was 50 years (SD ±6.54). Triphasic CT abdomen pancreatic protocol was the most effective modality of investigation. High bilirubin (>10 mg/dl) and back pain were statistically significant among patients with unresectable tumor. Conclusions: Back pain and high bilirubin could be helpful in pre-operative prediction of operability of periampullary cancers.
The information in this slide show is the intellectual property of James Waisman, M.D. Written permission is required to use content found in this document.
Physical Therapy is an integral part of breast cancer rehabilitation. Those undergoing treatments for breast cancer often face surgery. Physical therapists can work with women to alleviate symptoms caused by surgical intervention or medical treatment for cancer. The Prospective Surveillance Model, or PSM, is a proactive approach to periodically examining patients and providing continued assessment during and after disease treatment, often in the absence of impairment.
Learn about the latest research and treatment for ER+ breast cancer. Erica Mayer, MD, MPH, medical oncologist with the Susan F. Smith Center for Women's Cancers, discusses new clinical trials and treatment options for this subset of breast cancer patient.
This presentation was originally given on Oct. 17, 2015, at the Metastatic Breast Cancer Forum, hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Triple Negative Breast Cancer and Women of Color (Slide 1)bkling
In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month.
Tried to summarise all landmark trials in carcinoma breast in radiation oncology,medical oncology as well in surgical oncology.
References taken from Devita Book,Breast Disease book from Springer,journals like NEJM,JAMA,LANCET,ANNL ONCOLOGY etc,internet,Perez book,Practical Clinical Oncology by Hanna etc textbooks.
Thanks.
Join Dr. Erica Mayer, medical oncologist at Dana-Farber/Brigham and Women's Cancer Center, to learn about exciting metastatic breast cancer developments from the past year. Dr. Mayer presents an overview on metastatic breast cancer and the subgroups, including Hormone Receptive, HER2+, and Triple Negative, and highlights recent advances for each of these subgroups. She also discusses the importance of clinical trials and what it means to participate in a clinical trial.
For more information on the Breast Cancer Treatment Center at Dana-Farber Cancer Institute, please visit:
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Treatment-Centers-and-Clinical-Services/Breast-Cancer-Treatment-Center.aspx
New Predictors for Periampullary Resectabilityasclepiuspdfs
Background: Periampullary tumor involves ampullary, pancreatic, biliary and duodenal mucosa, and pancreaticoduodenectomy considered the curative option. Hence, imaging evaluation to describe the lesion is important. Furthermore, certain specific features could help in pre-operative prediction of resectability for periampullary cancers. The aim of this study is to find out any specific perioperative predictor of resectability on periampullary cancers. Patients and Methods: This is an observational cross-sectional hospital-based study done in tertiary hospital, a total of 79 patients were included in the study. Variables such as age, gender, symptoms (back pain, jaundice, etc.), investigations (bilirubin, alkaline phosphatase, etc.), and imaging (Triphasic computed tomography [CT], magnetic resonance cholangiopancreatography, endoscopic ultrasonography, etc.) were studied and the data collected and analyzed using SPSS 20. Results: Male was slightly predominant and male to female ratio was 1:0.9. The mean age was 50 years (SD ±6.54). Triphasic CT abdomen pancreatic protocol was the most effective modality of investigation. High bilirubin (>10 mg/dl) and back pain were statistically significant among patients with unresectable tumor. Conclusions: Back pain and high bilirubin could be helpful in pre-operative prediction of operability of periampullary cancers.
RESEARCH & TREATMENT NEWS: Highlights from the 2014 GI Cancer SymposiumFight Colorectal Cancer
Each January, the brightest minds in colorectal cancer research meet at the Gastrointestinal Cancer Symposium.
Fight Colorectal Cancer and The Colon Cancer Alliance are partnering to bring you the big news in colorectal cancer from the symposium. Dr. Allyson Ocean will be presenting.
Get insights about new types of treatments on the horizon, diagnostic tests available, research for upcoming drugs/biomarkers and the way colorectal cancer is treated. We’ll take a look back and a look forward. You’re not going to want to miss it.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
How to have quality of life in Advanced ovarian malignancyRajesh Gajbhiye
Presentation given by Dr Rakhi Gajbhiye, Mauli Hospital Nagpur at MGIMS sewagram for an International conference on Womens Health Fatal Disorders Survival with Quality in collaboration with FOGSI.
This was the function to commemorate 100 th birth centenary of Dr Sushila
Protocol for the Treatment Prostate Cancer - Dr Serge JurasunasSheldon Stein
Dr. Serge Jurasunas shares his Prostate Cancer Protocol in this paper, explaining the nature and treatment of Prostate Cancer from a Naturopathic Oncology Perspective. Professor Jurasunas is located in Lisbon Portugal and has lectured worldwide throughout his 50 years as a clinician.
He explains what can be done about the #1 cause of death in males even before lung cancer and what can be done, from the new perspective of Naturopathic Oncology.He offers an example, explains diagnostic procedures with Molecular markers and addresses detox, supplements and treatment.
Further information may be found in his new book, Health and Disease Begin in the Colon" and in his Blog: Naturopathiconcology.blogspot.com .
Pathology and Oncology Expert Perspectives in the Management of Triple-Negati...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck, presented by Dr. Ira Bleiweiss, Chief of Breast Pathology at the University of Pennsylvania, and Dr. Sara Tolaney, Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, will feature expert pathology and oncology perspectives on the management of triple-negative breast cancer (TNBC), including case explorations and insights into frequently asked questions. Register today to hear these expert perspectives!
Statement of Need
Triple-negative breast cancer (TNBC) is an aggressive disease that accounts for approximately 10% to 15% of breast cancer diagnoses and is characterized by the absence of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2). TNBC is more common in Black women and in women under the age of 40 (ACS, 2023). Compared with other subtypes of invasive breast cancer, TNBC has high rates of metastasis and a poor prognosis. Due to the lack of hormone and receptor targets, therapeutic options are limited, and prognostication and treatment selection are complicated by the heterogeneity of the disease (Yang et al, 2022). In this live webinar, Dr. Sara Tolaney, Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, and Dr. Ira Bleiweiss, Chief of Breast Pathology at the Hospital of the University of Pennsylvania, will provide expert oncology and pathology perspectives on evidence-based strategies for diagnosis, treatment, and adverse event management for patients with TNBC.
TARGET AUDIENCE
Medical oncologists, surgical oncologists, radiation oncologists, pathologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with triple-negative breast cancer (TNBC).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Evaluate receptor and expression status for prognostication and treatment selection in TNBC
Differentiate the pathological characteristics of the various types of TNBC
Select optimal therapy for TNBC based on shared goals, biomarker testing, and clinical data on novel therapies
Discuss strategies for timely recognition and mitigation of adverse events associated with novel TNBC therapies
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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1. Background parenchymal
enhancement in breast MRI before and
after neoadjuvant chemotherapy:
correlation with tumour response
Eur Radiol (2016) 26:1590–1596
By
DR. Naglaa Mahmoud
KCCC
2. Objectives
To correlate the decrease in background
parenchymal enhancement (BPE) and tumour
response measured with MRI in breast cancer
patients treated with neoadjuvant
chemotherapy (NAC).
4. Contrast enhancement of fibroglandular tissue on
magnetic resonance imaging (MRI) of the female
breast is referred to as background parenchymal
enhancement (BPE).
The amount of BPE is classified as minimal, mild,
moderate or marked according to the BI-RADS®
lexicon.
Although there are similarities in the
classifications, it was shown that BPE does not
correlate with the mammographic breast density.
5. In contrast-enhanced breast MRI, BPE is known
to be influenced by the hormonal status of the
patient.
BPE itself influences the accuracy of the
radiologist’s tumour size estimation, with
inaccurate estimation of the tumour size found
in patients with moderate and marked BPE.
6. The influence of breast cancer treatment on the
degree of BPE has been previously investigated.
In addition to surgical therapy, radiation,
chemotherapy and antihormonal medications are
well established in the treatment of breast cancer.
It was previously shown that whole breast radiation
after breast conserving therapy was associated with
a decrease of BPE in the irradiated breast.
A reduction of BPE in the contralateral breast was
also observed.
7. However, many of the patients were treated not
with radiotherapy alone but with additional
chemotherapy or antihormonal medication.
Hence, the reduction of BPE may have been
caused by any of these therapies or by their
combination.
A quantitatively measured reduction of BPE by
neoadjuvant chemotherapy (NAC) in the
contralateral breast has already been shown.
8. An almost complete suppression of BPE due to
Taxane containing NAC was observed in another
study.
A reduction of BPE due to antihormonal
medication has also been shown.
A reduction of BPE due to aromatase inhibitor
therapy was observed in approximately one-third
of the patients treated.
9. The decrease in BPE following Tamoxifen
treatment was observed in the first 90 days of the
treatment but did not significantly decrease any
further thereafter.
Additionally, this effect was partly reversible
because BPE increased again after the switch from
Tamoxifen to an aromatase inhibitor, which
caused a smaller reduction of BPE.
10. In the present study, none of the patients
received any treatment other than
chemotherapy before surgery.
Thus, the aim of this study was to analyse the
effects of NAC alone on BPE, as classified
according to the BI-RADS® 2013 categories, and
to analyse the relationship between the change
in BPE and tumour response.
12. All patients who presented with biopsy-proven breast
cancer during a time period of 24 months were analysed to
identify those who received NAC.
73 patients with 80 breast cancers treated with NAC were
retrospectively reviewed.
The inclusion criteria were that the patient received at least
6 cycles of chemotherapy and that MRI data were available
from both before and after NAC.
The mean patient age at the time of the breast cancer
diagnosis was 48.5±9.9 years (26.8–71.2 years).
13. The pre- or postmenopausal status of the
patients was noted, as were the tumour
characteristics, such as the cancer type (invasive
ductal, invasive lobular or other carcinomas),
hormone receptor status (oestrogen (ER),
progesterone (PR), human epidermal growth
factor receptor 2 (HER2) and nodal status.
Because all of the patients had biopsy proven
breast cancer, MRI was performed regardless of
the menstrual cycle to avoid a delay in
treatment.
15. MRI of the breast was performed using a 1.5 T MRI imager
(Philips Achieva, Hamburg, Germany) with a dedicated
7channel breast coil.
After a T2w STIR sequence in the transverse plane
(repetition time, 3,200 ms; echo time, 50 ms; inversion time,
160 ms; matrix, 512×512 pixels; field of view, 360 mm; slice
thickness, 3.5 mm), T1w gradient echo sequences (repetition
time, 7.5 ms; echo time, 3.7 ms; matrix, 512×512 pixels; field
of view, 400 mm; flip angle, 20°; slice thickness, 1.5 mm)
were acquired before and after intravenous (IV) injection of
0.16 mmol/kg body weight of gadolinium contrast medium
(Gadobutrol, Gadovist®, Bayer HealthCare AG, Berlin,
Germany).
16. Eight measurements were performed:
One before and seven after contrast agent
injection.
Subtraction images were produced using the
images obtained approximately 150 s after
injection and at the start of the injection (0 s).
Maximum intensity projections (MIP) were
obtained in the transverse, coronal and sagittal
planes.
18. All images from the 73 included patients were reviewed
by two radiologists (BW and HP) who, respectively, had 8
and 3 years of experience reading breast MR images.
The readers were aware that the patients had undergone
NAC because of breast cancer and reviewed the data sets
consecutively to determine the changes in BPE after NAC.
BPE was categorised into 4 BPE categories (BEC) that
ranged from 1 to 4, which indicated minimal, mild,
moderate and marked enhancement, respectively.
The readers were blinded to the other reader's results.
19.
20. The tumour response to NAC was classified
according to RECIST 1.1 criteria (complete
remission (CR), partial response (PR), stable
disease (SD) or progressive disease(PD).
The average (mean) baseline BPE before therapy
and the change in BPE after therapy in the cases
with a CR, PR, SD and PD were calculated and
compared to investigate whether the baseline BPE
or the change in BPE could predict the tumour
response in patients undergoing NAC.
22. 1-Tumour characteristics and response to therapy
Histopathological analysis showed that invasive
ductal carcinoma was present in 89 % (71/80) of
the patients, invasive lobular carcinoma in 10 %
(8/80) and invasive apocrine carcinoma in 1 %
(n=1).
The receptor analysis showed that 13 of 80
carcinomas were triple-negative.
23. 1-Tumour characteristics and response to therapy
Histopathological tumour response of the 80
tumours was a CR in 15 cases (19 %), PR in 44 cases
(57 %), SD in 10 cases (13 %) and PD in 8 cases (10
%).
The morphological response was CR in 17 cases (21
%), PR in 44 cases (55 %), SD in 10 cases (13 %) and
PD in 9 cases (11 %).
26. There was no change in BPE in 27 cases according
to reader 1 and in 25 cases according to reader 2.
A decrease in BPE was found in 53 cases according
to reader 1 and in 55 cases according to reader 2,
and neither reader noted an increase in BPE in any
case.
BPE was significantly higher in premenopausal
patients.
27. The change in BPE also differed significantly
between the groups.
Premenopausal women had a significantly greater
change, which indicated a higher reduction in BEC,
than did the non-premenopausal women, with a
mean reduction of 1.05 in premenopausal
compared with 0.50 in non premenopausal
women.
28. 3- Correlation analysis
BPE was analysed before and after NAC according to the
tumour response to investigate whether the baseline BPE
or the change in BPE could predict the tumour response
to NAC.
On average, BPE decreased by 0.87 BEC in all patients.
The correlation analysis showed a significant correlation
between the decrease in BEC and the tumour response,
which showed a stronger reduction of BPE in cases with a
better tumour response.
29. Based on the tumour response, the average
decrease in BEC was 1.3±0.099 categories for
cases with CR, 0.83±0.080 in cases with PR,
0.85±0.083 in cases with SD and 0.40±0.056 in
cases with PD.
The decrease in BEC was significantly higher in
the cases with CR than in those with PD.
30.
31.
32. The mean differences in BEC after NAC
subclassified based on the tumour responses is
shown.
According to reader 1, the average decrease in
BEC was 0.54 BEC in patients with PD, but
according to reader 2, it was 0.27 BEC.
35. In this study, authors analysed a cohort of cancer patients
with a mean age of 48.5 years old, the majority of the
patients presented with minimal or mild BPE, which is in
agreement with the values given in the literature.
These results emphasise the fact that in contrast to X-ray
mammography, MRI has a high assessability in most
patients.
The results show that this also holds true even if the
examination is not carried out between days 7 and 14 of
the menstrual cycle because the menstrual cycle is
neglected in patients with proven breast cancer.
36. There was a significant difference in BPE in
premenopausal women compared with non-
premenopausal women.
The change in BPE also differed between the
groups, with a significantly higher decrease in
premenopausal women than in peri or
postmenopausal women.
In this study, the baseline BPE before NAC did not
predict the tumour response.
37. In the present study, the decrease in BEC after the
completion of NAC was significantly higher in the
cases showing a complete remission compared
with progressive disease, and there was a slight
but significant correlation between the tumour
response and the change in BEC.
This observation may indicate that the degree of
the change in BPE can be considered a predictor of
the tumour response, especially in cases where
the exact tumour size and extension are difficult
to measure.
38. Conclusion
The degree of decrease in BPE on contrast-
enhanced MRI in patients undergoing NAC may be
a predictor of the tumour response.
The initial amount of BPE does not serve to predict
the tumour response.
Further studies are needed to investigate the
impact of BPE measurements on the disease-free
survival and overall survival.