Parenchymal Patterns Research Articles

Diffuse Pulmonary Ossification in Fibrosing Interstitial Lung Diseases: Prevalence and Associations.

Purpose To investigate the prevalence of diffuse pulmonary ossification (DPO) in patients with fibrosing interstitial lung disease (ILD) and determine whether there are differences among the types of ILDs. Materials and Methods Institutional review board approval was given and patient consent was not required for this study. The study population comprised 892 consecutive patients with fibrosing ILD, including 456 patients with idiopathic pulmonary fibrosis (IPF) (men, 366; women, 90; median age, 72 years [range, 38-93 years]), 244 with nonspecific interstitial pneumonia (men, 79; women, 165; median age, 60.5 years [range, 23-86 years]), and 192 with chronic hypersensitivity pneumonitis (men, 76; women, 116; median age, 66 years [range, 35-88 years]). Pulmonary ossifications were recorded when nodules (<4 mm diameter) were identified on bone window images (width, 2500 HU; level, 500 HU). DPO was defined as 10 or more bilateral nodular ossifications (definition 1) or as one or more lobes with five or more bilateral nodular ossifications (definition 2). Relationships among pulmonary ossification and parenchymal patterns, clinical parameters, and multidisciplinary team diagnoses were examined. The prevalence of DPO was compared with the χ2 statistic or Fisher exact test, and multivariate analysis was performed with logistic regression. Results In the whole population, the prevalence of DPO was 166 (18.6%) and 106 (11.9%) of 892 patients according to definitions 1 and 2, respectively. The prevalence of DPO (definition 1) was significantly higher in patients with IPF (28.5%) than in those without IPF (8.3%, P < .001). Nine of 192 (4.7%) had chronic hypersensitivity pneumonitis (P < .001), and 27 of 244 (11.1%) had nonspecific interstitial pneumonia (P < .001). At multivariate analysis, DPO according to definition 1 was an independent predictor of IPF diagnosis (P < .001) and male sex (P = .003). Coarseness of fibrosing ILD (P = .011) and IPF diagnosis (P = .016) were independently associated with pulmonary ossification profusion. Conclusion DPO is common in patients with fibrosing ILD and is significantly more prevalent in patients with IPF than in those with other fibrosing ILDs, and thus, computed tomographic signs of DPO may be helpful for diagnosis of IPF. © RSNA, 2017 Online supplemental material is available for this article.

Mammographic breast density and risk of breast cancer in women with atypical hyperplasia: an observational cohort study from the Mayo Clinic Benign Breast Disease (BBD) cohort

BackgroundAtypical hyperplasia (AH) and mammographic breast density (MBD) are established risk factors for breast cancer (BC), but their joint contributions are not well understood. We examine associations of MBD and BC by histologic impression, including AH, in a subcohort of women from the Mayo Clinic Benign Breast Disease Cohort.MethodsWomen with a diagnosis of BBD and mammogram between 1985 and 2001 were eligible. Histologic impression was assessed via pathology review and coded as non-proliferative disease (NP), proliferative disease without atypia (PDWA) and AH. MBD was assessed clinically using parenchymal pattern (PP) or BI-RADS criteria and categorized as low, moderate or high. Percent density (PD) was also available for a subset of women. BC and clinical information were obtained by questionnaires, medical records and the Mayo Clinic Tumor Registry. Women were followed from date of benign biopsy to BC, death or last contact. Standardized incidence ratios (SIRs) compared the observed number of BCs to expected counts. Cox regression estimated multivariate-adjusted MBD hazard ratios.ResultsOf the 6271 women included in the study, 1132 (18.0%) had low MBD, 2921 (46.6%) had moderate MBD, and 2218 (35.4%) had high MBD. A total of 3532 women (56.3%) had NP, 2269 (36.2%) had PDWA and 470 (7.5%) had AH. Over a median follow-up of 14.3 years, 528 BCs were observed. The association of MBD and BC risk differed by histologic impression (p-interaction = 0.03), such that there was a strong MBD and BC association among NP (p < 0.001) but non-significant associations for PDWA (p = 0.27) and AH (p = 0.96). MBD and BC associations for AH women were not significant within subsets defined by type of MBD measure (PP vs. BI-RADS), age at biopsy, number of foci of AH, type of AH (lobular vs. ductal) and body mass index, and after adjustment for potential confounding variables. Women with atypia who also had high PD (>50%) demonstrated marginal evidence of increased BC risk (SIR 4.98), but results were not statistically significant.ConclusionWe found no evidence of an association between MBD and subsequent BC risk in women with AH.

Automated computer-based CT stratification as a predictor of outcome in hypersensitivity pneumonitis.

Hypersensitivity pneumonitis (HP) has a variable clinical course. Modelling of quantitative CALIPER-derived CT data can identify distinct disease phenotypes. Mortality prediction using CALIPER analysis was compared to the interstitial lung disease gender, age, physiology (ILD-GAP) outcome model. CALIPER CT analysis of parenchymal patterns in 98 consecutive HP patients was compared to visual CT scoring by two radiologists. Functional indices including forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco) in univariate and multivariate Cox mortality models. Automated stratification of CALIPER scores was evaluated against outcome models. Univariate predictors of mortality included visual and CALIPER CT fibrotic patterns, and all functional indices. Multivariate analyses identified only two independent predictors of mortality: CALIPER reticular pattern (p = 0.001) and DLco (p < 0.0001). Automated stratification distinguished three distinct HP groups (log-rank test p < 0.0001). Substitution of automated stratified groups for FVC and DLco in the ILD-GAP model demonstrated no loss of model strength (C-Index = 0.73 for both models). Model strength improved when automated stratified groups were combined with the ILD-GAP model (C-Index = 0.77). CALIPER-derived variables are the strongest CT predictors of mortality in HP. Automated CT stratification is equivalent to functional indices in the ILD-GAP model for predicting outcome in HP. • Computer CT analysis better predicts mortality than visual CT analysis in HP. • Quantitative CT analysis is equivalent to functional indices for prognostication in HP. • Prognostication using the ILD-GAP model improves when combined with quantitative CT analysis.

Mammographic Parenchymal Patterns in Asymptomatic Women.

Background:Breast density has been found to be an independent risk factor for breast cancer. Mammographic breast parenchymal pattern or percent density is mainly a reflection of the proportion of glandular tissue to fatty tissue, and studies have shown that it works synergistically with other risk factors such as nulliparity in predicting breast cancer risk. This study analyses the various mammographic breast patterns and correlates this with some demographic variables and final Breast Imaging Reporting and Data System outcomes of asymptomatic women in our center.Materials and Methods:This is a prospective descriptive study of mammographic breast pattern in 459 females who presented at the breast imaging suite of our institution. Mammography was performed after completion of an assisted administered questionnaire for demographic information. A GE Senographe DMR machine using two standard views (craniocaudal and mediolateral oblique) and additional views were used when necessary.Results:A total of 459 women ranging in age from 34 to 80 years were included in the study, of which 46.6% were in the age range of 41 to 50 years. The scattered fibroglandular pattern was the most common pattern found (44%), and the homogeneous dense pattern was the least common (0.4%). A significant association with age and menopause status was found, while no association was found with age at the time of the woman's first delivery and family history of breast cancer.Conclusion:This study demonstrates that there is a significant association between breast cancer and age and menopause status. However, no correlation was found with the age of women at their first delivery and family history of breast cancer.

Left-right analysis of mammary gland development in retinoid X receptor-α+/- mice.

Left-right (L-R) differences in mammographic parenchymal patterns are an early predictor of breast cancer risk; however, the basis for this asymmetry is unknown. Here, we use retinoid X receptor alpha heterozygous null (RXRα+/-) mice to propose a developmental origin: perturbation of coordinated anterior-posterior (A-P) and L-R axial body patterning. We hypothesized that by analogy to somitogenesis-in which retinoic acid (RA) attenuation causes anterior somite pairs to develop L-R asynchronously-that RA pathway perturbation would likewise result in asymmetric mammary development. To test this, mammary glands of RXRα+/- mice were quantitatively assessed to compare left- versus right-side ductal epithelial networks. Unlike wild-type controls, half of the RXRα+/- thoracic mammary gland (TMG) pairs exhibited significant L-R asymmetry, with left-side reduction in network size. In RXRα+/- TMGs in which symmetry was maintained, networks had bilaterally increased size, with left networks showing greater variability in area and pattern. Reminiscent of posterior somites, whose bilateral symmetry is refractory to RA attenuation, inguinal mammary glands (IMGs) also had bilaterally increased network size, but no loss of symmetry. Together, these results demonstrate that mammary glands exhibit differential A-P sensitivity to RXRα heterozygosity, with ductal network symmetry markedly compromised in anterior but not posterior glands. As TMGs more closely model human breast development than IMGs, these findings raise the possibility that for some women, breast cancer risk may initiate with subtle axial patterning defects that result in L-R asymmetric growth and pattern of the mammary ductal epithelium.This article is part of the themed issue 'Provocative questions in left-right asymmetry'.

Beyond breast density: a review on the advancing role of parenchymal texture analysis in breast cancer risk assessment.

BackgroundThe assessment of a woman’s risk for developing breast cancer has become increasingly important for establishing personalized screening recommendations and forming preventive strategies. Studies have consistently shown a strong relationship between breast cancer risk and mammographic parenchymal patterns, typically assessed by percent mammographic density. This paper will review the advancing role of mammographic texture analysis as a potential novel approach to characterize the breast parenchymal tissue to augment conventional density assessment in breast cancer risk estimation.Main textThe analysis of mammographic texture provides refined, localized descriptors of parenchymal tissue complexity. Currently, there is growing evidence in support of textural features having the potential to augment the typically dichotomized descriptors (dense or not dense) of area or volumetric measures of breast density in breast cancer risk assessment. Therefore, a substantial research effort has been devoted to automate mammographic texture analysis, with the aim of ultimately incorporating such quantitative measures into breast cancer risk assessment models. In this paper, we review current and emerging approaches in this field, summarizing key methodological details and related studies using novel computerized approaches. We also discuss research challenges for advancing the role of parenchymal texture analysis in breast cancer risk stratification and accelerating its clinical translation.ConclusionsThe objective is to provide a comprehensive reference for researchers in the field of parenchymal pattern analysis in breast cancer risk assessment, while indicating key directions for future research.

Correlation of Breast Ultrasound Classifications with Breast Cancer in Chinese Women

The aim of this study was to identify potential links between ultrasonographic breast parenchymal patterns and the risk of breast cancer in Chinese women. The population of Chinese women at high risk for breast cancer was explored using the ultrasonographic classification. Ultrasonographic parenchymal patterns were classified into four types: heterogeneous type, ductal type, mixed type and fibrous type. A total of 5879 Chinese women underwent breast ultrasound examination from May 2010 to April 2014. Of the 5879 women, 256 women had pathology-confirmed breast cancer. Among the remaining 5623 women, 512 randomly selected, age-matched women were recruited into the present study. The correlation between ultrasonographic type and breast cancer revealed that the odds ratio (OR) was highest for the heterogeneous type (odds ratio = 4.11, 95% confidence interval: 2.01–8.41, p < 0.001), followed by the fibrous type (odds ratio = 2.05, 95% confidence interval: 1.51–2.78, p < 0.001). The odds ratios of the ductal and mixed types were both less than 1 (p < 0.05). This study indicates that the heterogeneous and fibrous types in the ultrasonographic classification are associated with an increased risk of breast cancer and, therefore, can be used as a marker of breast cancer risk in the female population of China.

The "Superior Ledge": a Modification of the Standard Superomedial Pedicle Reduction Mammoplasty to Accentuate Nipple-Areola Complex Projection.

The superomedial pedicle parenchymal excision pattern for reduction mammaplasty has the benefits of a reproducible breast shape and improved superomedial fullness, but is limited by a susceptibility to nipple retraction. The senior author of this paper has formalized the "superior ledge" modification of the superomedial pedicle technique (SL-SMP) to address these limitations. To describe the technical details of the SL-SMP breast reduction technique and to analyze patient outcomes. The technique involves only partial-thickness parenchymal excision superolateral to the pedicle, thereby leaving a "superior ledge" of parenchyma on top of which the nipple-areola complex (NAC) rests in a tension-free manner. Postoperative photographs were recorded; and patient demographics, intraoperative details, complications, and outcomes were recorded and analyzed. One hundred seven patients underwent SL-SMP reduction mammaplasty between 2007 and 2013. Complications included wound-healing complications (9.3%), infection (2.8%), seroma (1.9%), and hematoma (1.9%). Mean follow-up was 44.6months (Range: 17-72), and during that period no incidence of clinically relevant NAC retraction was noted by either the patient or surgical team. Maintenance of a distinct superior ledge underlying the final position of the NAC is an important modification to stress, to prevent nipple retraction. Importantly, the height of the ledge can be personalized for each patient. We feel it is a valuable addition to the plastic surgeon's armamentarium to optimize outcomes for patients seeking relief from excessive breast tissue. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract 4346: Adolescent fiber intake and mammographic breast density in premenopausal women

Abstract Background: Some, but not all, previous studies have suggested that higher adolescent fiber intake may be associated with a reduced risk of breast cancer. Consistently, adolescent fiber intake has been suggested to reduce breast cancer risk in adulthood in some of the previous studies. To date, there is limited epidemiologic evidence that diet has a strong influence on mammographic density and inconsistency in results for specific dietary factors. While some earlier studies demonstrated an inverse association between adolescent fiber intake and breast density (defined as parenchymal patterns), a more recent study did not find significant associations. We investigated the associations of adolescent fiber intake with mammographic density, a strong and consistent predictor of breast cancer, in premenopausal women. This is by far the largest study that investigated these associations. Methods: This study included 743 premenopausal women within the Nurses’ Health II cohort with no history of breast or other cancer. Percent breast density, absolute dense and non-dense areas were measured from digitized film mammographic images using a computer-assisted thresholding technique. Adolescent and adult diet was assessed with a food frequency questionnaire and energy-adjusted nutrient intakes were estimated for each of the questionnaires. Information regarding breast cancer risk factors was obtained from baseline or biennial questionnaires, closest to the mammogram date. We used generalized linear regression to quantify associations between quartiles of adolescent fiber intake and each of the breast density measures, adjusting for age, body mass index, and other known and suspected predictors of mammographic density. Absolute measures were square root-transformed in analyses to improve normality. Associations were examined separately for total fiber intake; fiber from fruits, vegetables, legumes, and cereal; and food sources of fiber (fruits, vegetables, and nuts). Results: In multivariable analyses, total fiber intake during adolescence was not associated with percent breast density (p for trend = 0.64), absolute dense area (p for trend = 0.80), or non-dense area (p for trend = 0.75). Similarly, neither consumption of nuts, fruits, or vegetables nor specific sources of fiber intake (fruits, vegetables, legumes, or cereal) during adolescence were associated with any of the mammographic density phenotypes. Conclusions: Our findings do not support the hypothesis that adolescent fiber intake is associated with premenopausal mammographic density. If observed associations with breast cancer risk are causal, then the effect may not be mediated through mammographic density. Citation Format: Lusine Yaghjyan, Gabriella Ghita, Maryam Farvid, Bernard Rosner, Kimberly A. Bertrand, Rulla Tamimi. Adolescent fiber intake and mammographic breast density in premenopausal women. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4346.

Mammographic density and structural features can individually and jointly contribute to breast cancer risk assessment in mammography screening: a case-control study.

BackgroundMammographic density is a well-established risk factor for breast cancer. We investigated the association between three different methods of measuring density or parenchymal pattern/texture on digitized film-based mammograms, and examined to what extent textural features independently and jointly with density can improve the ability to identify screening women at increased risk of breast cancer.MethodsThe study included 121 cases and 259 age- and time matched controls based on a cohort of 14,736 women with negative screening mammograms from a population-based screening programme in Denmark in 2007 (followed until 31 December 2010). Mammograms were assessed using the Breast Imaging-Reporting and Data System (BI-RADS) density classification, Tabár’s classification on parenchymal patterns and a fully automated texture quantification technique. The individual and combined association with breast cancer was estimated using binary logistic regression to calculate Odds Ratios (ORs) and the area under the receiver operating characteristic (ROC) curves (AUCs).ResultsCases showed significantly higher BI-RADS and texture scores on average than controls (p < 0.001). All three methods were individually able to segregate women into different risk groups showing significant ORs for BI-RADS D3 and D4 (OR: 2.37; 1.32–4.25 and 3.93; 1.88–8.20), Tabár’s PIII and PIV (OR: 3.23; 1.20–8.75 and 4.40; 2.31–8.38), and the highest quartile of the texture score (3.04; 1.63–5.67). AUCs for BI-RADS, Tabár and the texture scores (continuous) were 0.63 (0.57–0–69), 0.65 (0.59–0–71) and 0.63 (0.57–0–69), respectively. Combining two or more methods increased model fit in all combinations, demonstrating the highest AUC of 0.69 (0.63-0.74) when all three methods were combined (a significant increase from standard BI-RADS alone).ConclusionOur findings suggest that the (relative) amount of fibroglandular tissue (density) and mammographic structural features (texture/parenchymal pattern) jointly can improve risk segregation of screening women, using information already available from normal screening routine, in respect to future personalized screening strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2450-7) contains supplementary material, which is available to authorized users.

Ultrasound assessment of perinatal testicular torsion.

The goal of this study was to elucidate the different sonographic features of prenatal and postnatal testicular torsion (TT) using high-frequency colour Doppler ultrasound (HCDU) in an effort to increase diagnostic accuracy. 29 patients (average age, 7.5 days) with perinatal TT were divided into patients with postnatal (acute) TT vs patients with prenatal (chronic) TT and their clinical characteristics, imaging features on HCDU and surgical pathology results were retrospectively analyzed. Significant differences were observed between prenatal and postnatal TT cases with regard to testicular size (p = 0.01) and echogenicity (p = 0.007). All 17 prenatal cases had non-homogeneous testicular parenchymal echo patterns compared with only 9 (64.3%) postnatal TT cases. Five postnatal TT cases presented with homogeneous echo patterns compared with none of the prenatal TT cases. Testicular blood supply was absent in 25 (80.7%) of 31 testes on colour Doppler flow imaging, with the majority occurring in the prenatal TT cases [i.e. 16 (94.1%) cases]. 1 affected testis out of a total 17 testes from 16 patients with prenatal TT was salvaged, with a salvage rate of 1/17 or 0.06%. 7 affected testes out of a total 16 testes from 13 patients with postnatal neonatal TT were salvaged, with a salvage rate of 7/16 or 43.8%. In neonates with acute scrotal symptoms, the possibility of perinatal TT should be considered and HCDU examination should be performed in a timely manner. HCDU examination could aid in testicular salvage by prompting quick surgical intervention. This study underlined the clinical contribution of HCDU in evaluating postnatal (acute) vs prenatal (chronic) TT. The sonographic features of postnatal TT with salvageable testes were compared with prenatal torsion and the relative salvage rates in both cases were discussed.

Epidemiology of breast cancer among the female patients in Bangladesh

Breast cancer was the commonest cancer among the female patients who attended Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh, which formed the second most common cancer worldwide. An expressive cross-sectional study was conceded out in NICRH. By convenience sampling, 322 female patients were selected. A design and well formatted pre-tested questionnaire was used to ask questions among the breast cancer patients. The objectives of the study was to investigate the distribution and determinants of breast cancer among the female patients admitted in NICRH. The period of the study was during July 2010 to June 2011. Majority (71 %) of the patients was in the age between 34 to 53 years and they were coming from rural areas. About 77 % respondents had experienced first menstruation in the age between 12 to 13 years. It was found that 42 % respondents gave their first child birth in between 21 to 25 years age and among all the respondent 64 % became pregnant up to 3 times. It also noted that 89 % respondents had practice to use oral contraceptives. While trying to get their history of contraceptive use; it was found that 42 % used contraception in between 4 to 6 years. In this study we found that 90 % of the respondent’s had the practice to breast fed their baby. But 24 % of the respondent’s have used HRT and among them 69 % had used it by ≤3 years. Around 56 % respondents had the parenchymal pattern of breast in mammography. Forty two percent respondent’s had the history of disease on breast cancer and 25 % had the history of benign breast cancer and also 2 % had the experiences to use radiation. This study explored the overall scenario of breast cancer among the patients admitted to NICRH in Bangladesh context; understanding the different type of determinants, risk factors to developing breast cancer and the distribution of patients in different area which will help to build up the national awareness. Measure should be taken immediately to detect the factors that were associated with breast cancer. This study was a very little one in respect of the national situation in our country and the result reflected only a fraction of the original condition. Broad based study in large population with sound methodology is required to find out real situation about this matter in Bangladesh.

MR imaging features of liver involvement by Wilson disease in adult patients.

To describe the magnetic resonance imaging (MRI) presentation of liver involvement in adult patients with Wilson disease (WD) and determine the most indicative appearance of this condition on MRI using a retrospective case-control study. MRI examinations of 23 adult patients with WD (14 men, 9 women; mean age=40.4years) were analyzed by two blinded observers and compared to those obtained in 23 patients with chronic viral hepatitis (14 men, 9 women, mean age=40.4years) who were matched for age, gender and severity of chronic liver disease. Images were qualitatively and quantitatively analyzed with respect to imaging presentation. Comparisons were performed using univariate analysis. Honeycomb pattern of hepatic parenchyma was the most discriminating independent variable for the diagnosis of WD (odds ratio, 17.082; 95% CI 2.092-139.497) (P=0.0081) but had a sensitivity of 43% (10/23; 95% CI 23-66%). Regular liver contours was the other variable that strongly correlated with the presence of liver involvement by WD (odds ratio, 11.939; 95% CI 1.503-94.836) (P=0.0190). The honeycomb pattern is the most discriminating independent variable for the diagnosis of liver involvement by WD but has limited sensitivity. Familiarity with this finding may clarify the cause of diffuse hepatic parenchymal abnormalities in patients with unknown WD.

Mammographic parenchymal patterns and breast cancer risk in New South Wales North Coast Aboriginal and Torres Strait Islander women.

IntroductionThe objective of the study was to document the distribution of mammographic parenchymal patterns (MPP) of Indigenous Australian women attending BreastScreen New South Wales (NSW) North Coast, to profile breast cancer risk as it relates to breast density and to explore the correlation between MPP, breast size as described by the posterior nipple line (PNL) and age.MethodsEthics was granted from CQUniversity Human Research Ethics Committee, NSW Population Health Services Research Ethics Committee and the Aboriginal Health and Medical Research Council Ethics Committee. A quantitative retrospective analysis reviewed 502 screening mammograms against the Tabár I–V MPP classification system. The PNL was measured in millimetres (mm) and the age of the patient documented.ResultsA statistically significant variation in the distribution of MPP (P < 0.0001) was demonstrated, with patterns of I (23.9%), II (45.6%), III (10.4%), IV (15.9%) and V (4.2%). Statistically significant differences were noted in the age of subjects between patterns (P = 0.0002). Patterns I and V demonstrated statistically significant lower ages than II, III and IV (all P < 0.05). Pattern V demonstrated a statistically significant lower age than pattern I (P = 0.0393). Pattern V demonstrated a statistically significant lower PNL value than all other patterns (all P < 0.001/P < 0.0002); pattern II was statistically significantly higher in PNL value than all other patterns (P < 0.002/P < 0.001). No significant relationship was noted between PNL and age.ConclusionThe study demonstrated that no identifiable or unique distribution of MPP was noted in this snapshot of Indigenous women. A larger study of Indigenous Australian women is required for validation.

Abstract P6-09-05: No evidence of association between mammographic breast density and risk of breast cancer in women with atypical hyperplasia

Abstract Background Women with atypical hyperplasia (AH) are at an approximately four-fold increased risk of subsequent breast cancer (BC). Mammographic breast density (MBD) is a well-established risk factor for BC, but its contribution to BC risk in women with AH remains an open question. We previously reported no association between MBD [measured by Wolfe's parenchymal pattern (PP)] and BC risk in a cohort of 147 women with AH. Here, we present results in an expanded cohort of 459 women diagnosed with AH between 1985 and 2001. Methods The Mayo Clinic Benign Breast Disease Cohort includes 13,485 women who had benign core and/or excisional biopsy 1967-2001. Biopsy tissues were reviewed by our study pathologist to determine presence of AH. MBD was available from clinical records starting in 1985, coded as PP (the standard for 1985-1996) or BI-RADS (1997-2001) density criteria. The original four-level PP (N1-fatty, P1-ductal prominence &amp;lt;25% of breast, P2-ductal prominence &amp;gt;25%, DY-dysplasia) and BI-RADS (fatty, scattered densities, heterogeneously dense, extremely dense) measures were re-categorized as low, moderate or high MBD by combining the middle two categories for each. BC events and clinical information were obtained by questionnaires, medical records and the Mayo Clinic Tumor Registry. Women were followed from benign biopsy to date of BC, death or last contact. Standardized incidence ratios (SIRs) were generated overall and within subgroups defined by density measure (PP vs. BI-RADS), number of atypical foci, and BMI by dividing the observed number of BCs by population-based expected values. Cox regression was used to estimate MBD hazard ratios after adjustment for demographic and clinical variables. Results Of the 551 women diagnosed with AH between 1985 and 2001, 459 (83%) had MBD data within 1 year prior to biopsy. Of these, 68 (15%) had low, 221 (48%) had moderate, and 170 (37%) had high MBD, respectively. Over a median follow-up of 11.7 years, 80 BCs were observed. SIRs for breast cancer did not differ significantly across density categories, overall or within any subgroups examined (see Table). Cox regression adjusting for age, BMI and density measure (PP vs. BI-RADS) also failed to identify an association with MBD (p=0.55). Low MBDModerate MBDHigh MBD N / BCsSIR (95% CI)N / BCsSIR (95% CI)N / BCsSIR (95% CI)P-valueOverall68/123.5 (1.8,6.1)221/393.6 (2.5,4.9)170/293.4 (2.3,4.8)0.97MBD Measure PP59/113.6 (1.8,6.5)85/153.0 (1.7,5.0)130/243.3 (2.2,5.0)0.87BI-RADS9/12.7 (0.1,14.7)136/244.0 (2.6,6.0)40/53.4 (1.1,7.9)0.90No. Atypical Foci 147/62.3 (0.9,5.1)123/182.8 (1.7,4.4)96/163.5 (2.0,5.8)0.63214/47.5 (2.0,19.1)58/134.8 (2.6,8.3)41/62.5 (0.9,5.5)0.213+7/26.7 (0.8,24.0)40/84.4 (1.9,8.6)33/74.0 (1.0,8.2)0.83BMI &amp;lt;2525/21.5 (0.2,5.4)75/184.9 (2.9,7.7)101/173.4 (2.0,5.5)0.1625-2919/54.9 (1.6,11.3)68/92.8 (1.3,5.2)36/42.1 (0.6,5.4)0.4530+23/54.8 (1.6,11.2)76/123.0 (1.6,5.3)32/74.0 (1.6,8.2)0.67SIRs compare observed numer of BCs to expected using Iowa SEER data. Analyses account for the effects of age and calendar period. P-value is test of heterogeneity in SIRs across columns. Conclusions We found no evidence of an association between MBD and subsequent BC in women with AH. Citation Format: Vierkant RA, Degnim AC, Hartmann LC, Frank RD, Radisky DC, Visscher DW, Frost MH, Winham SJ, Ghosh K, Vachon CM. No evidence of association between mammographic breast density and risk of breast cancer in women with atypical hyperplasia. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-05.

Abstract P4-01-02: Identification of histopathologic determinants of mammographic breast density as a cancer risk factor

Abstract Background: Mammographic density and texture, the amount and appearance of fibroglandular tissue respectively, are known to be strong predictors of a woman's risk to develop breast cancer. However, how differences in underlying tissue biology are associated with the wide range of breast density patterns seen among women is currently unknown. Understanding the biological mechanisms driving breast density can be critical for developing targeted interventions aimed at reducing a woman's risk for breast cancer. Methods: Digital mammograms and formalin-fixed paraffin-embedded biopsy tissue sections from 73 women who donated breast tissue to the Susan G. Komen for the Cure Tissue Bank at the Indiana University Simon Cancer Center were included in this analysis. Hematoxylin and eosin (H&amp;E) and AE1/AE3 cytokeratin stains were applied to the tissue sections, which were then visually characterized by an expert breast pathologist. H&amp;E stains were used to assess the presence (in ≥5% of the tissue section) or absence of non-proliferative fibrocystic changes, proliferative fibrocystic changes without atypia, inflammatory and reactive conditions, or benign tumors. AE1/AE3 stains were used to quantify the extent of epithelial and stromal content, as well as the number of lobules and ductal structures seen in the section. Quantitative breast percent density (PD%) and whole-breast texture analysis was performed on the digital mammograms using validated software. Parenchymal texture measures recently demonstrated to be associated with breast cancer risk were assessed, including the gray-level co-occurrence features Cluster-shade, Correlation, Energy, Entropy, Inertia and Inverse Difference Moment. Texture was characterized within a 2.5cm2 area of interest in the upper-outer quadrant of the mammograms corresponding to the approximate location of the biopsy. Partial-R2 (pR2) analysis was applied in order to assess the proportion of the variability in the mammographic texture which can be directly attributed to underlying histological properties after adjusting for race, menopausal status, body mass index, PD% and mammography unit manufacturer, utilizing a false-discovery-rate (FDR) multiple comparisons correction. Results: The presence of proliferative fibrocystic changes without atypia was found to have a significant association to Correlation (pR2=0.21), Energy (pR2=0.13), Entropy (pR2=0.16), and Inverse Difference Moment (pR2=0.14) at the FDR-corrected significance level of p&amp;lt;0.0042, even after adjusting for race, menopausal status, body mass index, PD% and the mammography unit manufacturer. These findings suggest that 13-21% of the variation in parenchymal texture patterns seen between women can be explained by the presence of proliferative fibrocystic changes without atypia, a common and well known risk factor for breast cancer. Conclusion: In this study, we identified proliferative fibrocystic changes without atypia as one potential driver of image-based biomarkers of breast cancer risk. Ultimately, identification of radiographic biomarkers of tissue microenvironment could aid in the development of targeted chemopreventative interventions for women with dense breast tissue while simultaneously providing image-based biomarkers to monitor their efficacy. Citation Format: Keller BM, Batiste RC, Chen J, McDonald ES, Conant EF, Kontos D, Feldman MD. Identification of histopathologic determinants of mammographic breast density as a cancer risk factor. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-01-02.

Mammographic Ellipse Modelling for Risk Estimation

It has been shown that breast density and parenchymal patterns are significant indicators in mammographic risk assessment. In addition, studies have shown that the sensitivity of computer aided tools decreases significantly with increase in breast density. As such, mammographic density estimation and classification plays an important role in CAD systems. In this paper, we present the classification of mammographic images according to breast parenchymal structures through a multi-scale ellipse blob detection technique. Our classification is based on classifying the mammographic images of the MIAS dataset into high/low risk mammograms based on features extracted from a blob detection technique which is based on breast tissue structure. In addition, it evaluates the relation between the BIRADS classes and low/high risk mammograms. Results demonstrate the probability of estimating breast density using computer vision techniques to improve classification of mammographic images as low/high risk.

Population of 224 realistic human subject-based computational breast phantoms.

To create a database of highly realistic and anatomically variable 3D virtual breast phantoms based on dedicated breast computed tomography (bCT) data. A tissue classification and segmentation algorithm was used to create realistic and detailed 3D computational breast phantoms based on 230 + dedicated bCT datasets from normal human subjects. The breast volume was identified using a coarse three-class fuzzy C-means segmentation algorithm which accounted for and removed motion blur at the breast periphery. Noise in the bCT data was reduced through application of a postreconstruction 3D bilateral filter. A 3D adipose nonuniformity (bias field) correction was then applied followed by glandular segmentation using a 3D bias-corrected fuzzy C-means algorithm. Multiple tissue classes were defined including skin, adipose, and several fractional glandular densities. Following segmentation, a skin mask was produced which preserved the interdigitated skin, adipose, and glandular boundaries of the skin interior. Finally, surface modeling was used to produce digital phantoms with methods complementary to the XCAT suite of digital human phantoms. After rejecting some datasets due to artifacts, 224 virtual breast phantoms were created which emulate the complex breast parenchyma of actual human subjects. The volume breast density (with skin) ranged from 5.5% to 66.3% with a mean value of 25.3% ± 13.2%. Breast volumes ranged from 25.0 to 2099.6 ml with a mean value of 716.3 ± 386.5 ml. Three breast phantoms were selected for imaging with digital compression (using finite element modeling) and simple ray-tracing, and the results show promise in their potential to produce realistic simulated mammograms. This work provides a new population of 224 breast phantoms based on in vivo bCT data for imaging research. Compared to previous studies based on only a few prototype cases, this dataset provides a rich source of new cases spanning a wide range of breast types, volumes, densities, and parenchymal patterns.

Comparison of MRI and digital breast tomosynthesis in the preoperative evaluation of multifocal breast cancer

Preoperative assessment of tumour extent is crucial in the management of breast cancer. MRI is currently indicated in cases of invasive lobular carcinoma on histology, a dense breast parenchymal pattern on 2D digital mammography (2DDM) or if there is a discrepancy between the clinical and radiological extent of disease. We compared the imaging characteristics of multifocal breast cancers on MRI, digital breast tomosynthesis (DBT), ultrasound and 2DDM to demonstrate the accuracy of each modality in the assessment of multifocal cancers.

Neurological manifestations of Behçet’s disease: 161 cases in one moroccan center

Introduction: Behçet’s disease (BD) is a chronic multisystemic inflammatory disease, predominant within the Mediterranean countries and characterized by oral, genital mucous ulcers and uveitis. Neurological involvement is one of the most serious complications of BD and represents a major cause of morbidity. Patients and methods: 161 moroccan cases of neurobehçet disease (NBD) have been categorized into two main groups: “Parenchymal” CNS involvement, which includes hemispheric, brain-stem, spinal, and multifocal presentations; and “non parenchymal” CNS involvement, which includes dural sinus thrombosis and arterial involvement. Results: Parenchymal CNS pattern was observed in 74% of our cases with a predominance of symptoms related to brainstem involvement (30%) such ophthalmoparesis, bulbar and pseudobulbar palsy. Other symptoms have been present with varying frequencies: cerebellar signs(52%), headache(52%), psychiatric and cognitive symptoms (34%), sphincter disturbances (22%), epilepsy (9%). Some features are less common such as optic neuropathy (2%) or peripheral neuropathy(1%). Non-parenchymal form was noted in 26% of our series essentially represented by cerebral venous thrombosis (CVT). Only 4 of cases have cerebral arterial involvement, three with intracranial aneurysm. All patients have cerebral imaging. Magnetic resonance imaging showed a caracteristic lesion in one third of our patients, located at the mesodiencephalic junction and the pontobulbar region. Treatment was based on corticosteroids in the two categories. Long-term maintenance with immunosuppressive agents was administrated in patients with parenchymal CNS involvement and anticoagulants in case of CVT. Conclusion: Neurological involvement represents a major complications of BD which requires early diagnosis and long terme management.