Diagnosis Of High-risk Lesions Research Articles

Combined SUVmax and localized colonic wall thickening parameters to identify high-risk lesions from incidental focal colorectal 18F-FDG uptake foci.

ObjectiveTo evaluate the detection ability of 18F-FDG PET/CT for identifying high-risk lesions (high-risk adenomas and adenocarcinoma) from incidental focal colorectal 18F-FDG uptake foci combining maximum standard uptake value (SUVmax) and localized colonic wall thickening (CWT). The secondary objective was to investigate the factors of missed detection of high-risk adenomas by 18F-FDG PET/CT.Patients and methodsA total of 6394 patients who underwent 18F-FDG PET/CT in our hospital from August 2019 to December 2021 were retrospectively analysed, and 145 patients with incidental focal colorectal 18F-FDG uptake foci were identified. The optimal cut-off value of SUVmax for 18F-FDG PET/CT diagnosis of high-risk lesions was determined by receiver operating characteristic (ROC) curves. SUVmax and localized CWT were combined to identify high-risk lesions from incidental focal colorectal 18F-FDG uptake foci. The characteristics of incidental adenomas detected and high-risk adenomas missed by 18F-FDG PET/CT were compared.ResultsOf the 6394 patients, 145 patients were found to have incidental focal colorectal FDG uptake foci (2.3%), and 44 patients underwent colonoscopy and pathological examination at the same time. In fact, 45 lesions, including 12 low-risk lesions and 33 high-risk lesions (22 high-risk adenomas, 11 adenocarcinoma), were found by colonoscopy. The area under the ROC curve of SUVmax for low-risk lesions and high-risk lesions was 0.737, and the optimal cut-off value was 6.45 (with a sensitivity of 87.9% and specificity of 58.3%). When SUVmax ≥6.45, the combination of localized CWT parameters has little influence on the sensitivity and specificity of detection; when SUVmax <6.45, the combination of localized CWT parameters can improve the specificity of detection of high-risk lesions, but the sensitivity has little change. In addition, the size of high-risk adenomas discovered incidentally by 18F-FDG PET/CT was larger than that of high-risk adenomas missed, but there was no significant difference in lesion location, pathological type or intraepithelial neoplasia between the two groups.ConclusionsThe combination of SUVmax and localized CWT parameters of 18F-FDG PET/CT helped identify high-risk lesions from incidental focal colorectal 18F-FDG uptake foci, especially for lesions with SUVmax <6.45. Lesion size may be the only factor in 18F-FDG PET/CT missing high-risk adenomas.

Effects of SARS-CoV-2 emergency measures on high-risk lesions detection: a multicentre cross-sectional study

COVID-19 pandemic enforced the interruption of routine endoscopic examinations raising the issue of potential delays in the diagnosis of high-risk lesions. We conducted a multicentre study to assess the decrease...

What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence.

Purpose To assess adherence with annual or biennial screening mammography after a diagnosis of high-risk lesion(s) at stereotactic biopsy with or without surgical excision and to identify clinical factors that may affect screening adherence after a high-risk diagnosis. Materials and Methods This institutional review board-approved HIPAA-compliant retrospective study included 208 patients who underwent stereotactic biopsy between January 2012 and December 2014 that revealed a high-risk lesion. Whether the patient underwent surgical excision and/or follow-up mammography was documented. Adherence of these women to a protocol of subsequent mammography within 1 year (9-18 months) or within 2 years (9-30 months) was compared with that of 45 508 women with normal screening mammograms who were imaged during the same time period at the same institution. Possible factors relevant to postdiagnosis management and screening adherence were assessed. Consultation with a breast surgeon was identified by reviewing clinical notes. Uptake of pharmacologic chemoprevention following diagnosis (patient decision to take chemopreventive medications) was assessed. The Fisher exact test was used to compare annual or biennial screening adherence rates. Binary logistic regression was used to identify factors predictive of whether women returned for screening within selected time frames. Results In total, 913 (1.3%) of 67 874 women were given a recommendation to undergo stereotactic biopsy, resulting in diagnosis of 208 (22.8%) of 913 high-risk lesions. Excluding those with a prior personal history of breast cancer or upgrade to cancer at surgery, 124 (66.7%) of 186 women underwent surgery and 62 (33.3%) did not. Overall post-high-risk diagnosis adherence to annual or biennial mammography was similar to that in control subjects (annual, 56.4% vs 50.8%, P = .160; biennial, 62.0% vs 60.1%, P = .630). Adherence was significantly better in the surgical group than in the nonsurgical group for annual mammography (70.0% vs 32.0%; odds ratio [OR] = 5.0; 95% confidence interval [CI]: 2.4, 10.1; P < .001) and for biennial mammography (74.3% vs 40.0%; OR = 4.3; 95% CI: 2.1, 8.8; P < .001). Among the patients in the nonsurgical group, those adherent to annual or biennial mammography were significantly more likely to have seen a breast surgeon than the nonadherent women (annual, 77.3% vs 35.7%, P = .005; biennial, 67.9% vs 36.4%, P = .045). All patients receiving chemopreventive agents underwent a surgical consultation (100%; n = 21). Conclusion Although diagnosis of a high-risk lesion at stereotactic breast biopsy did not compromise overall adherence to subsequent mammographic screening, patients without surgical excision, particularly those who did not undergo a surgical consultation, had significantly lower imaging adherence and chemoprevention uptake as compared with their counterparts who underwent surgery, suggesting that specialist care may be important in optimizing management. © RSNA, 2018.

Abstract P3-02-06: Magnetic resonance imaging (MRI) surveillance for patients with dense breasts and a previous breast cancer (BC) and/or high risk lesion

Abstract BACKGROUND AND PURPOSE The benefits of breast MRI for screening women at high risk of developing BC is established, but its role in women with a personal history of BC or dense breasts is unknown. We sought to estimate the performance of annual surveillance MRI added to mammography in women at moderately increased BC risk due to a personal history of breast cancer and/or a high-risk breast lesion and dense breasts. METHOD AND MATERIALS We performed a retrospective chart review of the clinical, radiological, and pathological parameters of women who received annual, concurrent surveillance breast MRI and mammography between 04/2013 and 12/2015. We included women who met all of the following criteria: age&amp;lt;69; prior diagnosis of high-risk lesion (ADH, ALH, LCIS), DCIS, or invasive BC; heterogeneously (50-75%) or extremely dense (&amp;gt;75%) breasts; and did not qualify for our provincial MRI screening program for high risk women (calculated lifetime BC risk ≥ 25%). Results of each scan were analyzed using descriptive statistics and Chi squared for comparisons between subgroups. RESULTS A total of 199 patients (267 MRI exams) were included in this study. The mean age at initial diagnosis was 45 years and at subsequent diagnosis of DCIS or invasive cancer was 53 years. Mean time to new diagnosis was 86 months (range 14-202). All 15 cancers diagnosed during the study period were MRI detected: 11 invasive stage I (66% IDC, 7% ILC) and 4 DCIS (27%). Of these 15, all but 1 were mammographically occult. Five (33%) were found in the breast ipsilateral to the original lesion. The cancer detection rate was 6% (12/199) on the first screening round and 4.7% (3/64) on the second screening round. Specificity and positive predictive value respectively for MRI exams increased from 77% and 22% on the first screening round to 88% and 30% on the second round. Of women who developed BC, 57% had a history of breast or ovarian cancer in a first degree relative. None of the 72 women who were on hormonal therapy at the time of surveillance imaging had a new cancer detected compared to 11% (14/125) of those who were not on hormonal therapy (p=0.0025). CONCLUSIONS The incremental early-stage BC detection rate and specificity of MRI in this population are comparable to what is observed in screening women at high risk. The addition of annual MRI to mammography should be considered for surveillance of women with a personal history of BC / premalignant lesion and heterogeneous / extremely dense breasts, particularly if they have a family history of BC and are not on hormonal therapy. Citation Format: Nadler M, Al Attar H, Curpen B, Martel AL, Balasingham S, Zhang L, Eisen A, Warner E. Magnetic resonance imaging (MRI) surveillance for patients with dense breasts and a previous breast cancer (BC) and/or high risk lesion [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-06.

The Effects of Preoperative Needle-Core Breast Biopsy on Resected Tissue Volume, Margin Status and Cosmetic Outcomes in Breast Conserving Surgery.

Abstract Background:The amount of breast volume excised is an important determinant for cosmetic outcomes after breast-conserving surgery. Positive margins after breast conserving surgery negatively influence cosmetic outcomes by necessitating re-excisions. In this study, our aim was to evaluate the hypothesis that preoperative localized needle-core breast biopsy (LNCB) diagnosis can reduce the resected volume, margin positivity and cosmetic discontent after breast conserving surgery. Methods:Two hundred sixty five women (mean age:57; range 16-85 years) operated upon by a single dedicated breast surgeon in the year 2007 form the cohort for this study. All underwent excision of lesion with curative intent. LNCB was performed before breast conserving surgery in 237 (89%) patients. The final pathology result were classified by benign, high risk, DCIS, or invasive cancer and compared with the pre-op pathological diagnosis by LNCB. The cosmetic results were determined as excellent, good, fair, or poor during the post-operative period. Associations between various factors were analyzed using Student-t test, ANOVA test and chi-square test. Results:The resected volume (mean±SD) of the patients with preoperative needle core biopsy was higher than patients without core biopsy (101.11±78.1 cm3 vs 43.37±30.8 cm3; p=0.001). The core biopsy results were 36 (15%) benign, 45 (19%) high risk, 46 (19.5%) DCIS, and 110 (46.5%) invasive breast cancer. The LNCB and surgical path were concordant in 96% of cases. The resected volumes were higher in invasive cancer and DCIS cases.Table: Preoperative needle-core breast biopsy characteristics (n=237). Benign disease (n=36)High risk (n=45)Ductal carcinoma in-situ (n=46)Invasive cancer (n=110)Pre-operative USG/Mammography/MRIA: 10 (27%) B: 26 (71%)A: 30 (66%) B: 15 (34)A: 37 (81%) B: 9 (19%)A: 10 (9%) B: 100 (91%)Initial resected volume (cm3)33.7964.17106.44123.8Total volume after re-excision (cm3)33.7965.66112.79132.77CosmesisE=36 (100%)E= 44 (98%) G= 1 (2%)E= 39 (85%) G= 6 (13%) F= 1 (2%)E= 84 (76%) G= 21 (19%) F= 5 (5%)A: Micro-calcification, B: Mass, E: Excellent, G: Good, F: Fair.Re-excision for positive margins were necessary in 9 (19.5%) of DCIS cases and 24 (21.8%) with a diagnosis of invasive cancer. Resection volumes were the same for a LNCB diagnosis of high risk lesion whether the final surgical path was benign or malignant (65.3±52.7 cm3 v. 69.8±8.7 cm3). The cosmetic outcomes of the surgery were excellent in 98% to 100% of patients who had lower volume resections; however, the outcome was less than excellent in 15% to 26% of patients if the final resection volume was more than 100 cm3. Conclusions: Pre-operative LNCB that establishes the benign nature of a lesion allows a more limited resection with improved cosmetic outcomes. Establishing the diagnosis of DCIS or invasive breast cancer by pre-operative biopsy allows for surgical planning of wider resection volumes, but the need for re-excision based on positive margins remains high, suggesting that newer imaging modalities that allow 3-demensional planning of segmental resection or even wider resections employing oncoplastic techniques are necessary. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1032.

P-464 Endoscopic fluorescence diagnosis of high risk lesions of bronchus

P-464 Endoscopic fluorescence diagnosis of high risk lesions of bronchus