Small Breast Tumors Research Articles

Breast lesions segmentation from ultrasound images using DeepLabV3 + model with channel and spatial attention mechanism

Segmenting breast tumors in ultrasound images is pivotal for computer-aided diagnosis (CAD) systems aimed at detecting breast cancer. This research contributes directly to the Sustainable Development Goal (SDG), good health and well-being by leveraging innovative deep learning technique to boost the accuracy of breast tumor segmentation. Achieving accurate segmentation is crucial for precise tumor size, shape, and location determination, which in turn facilitates subsequent tumor quantification and classification. However, this task presents challenges, particularly when dealing with small tumors. The complexity arises from factors such as speckle noise, variations in tumor shapes and sizes across patients, and the presence of tumor-like regions in the images. Although deep learning-based methods have shown remarkable success in biomedical image analysis, the current state-of-the-art approaches still struggle to achieve satisfactory performance in segmenting small breast tumors. In this paper, BUS (Breast Ultrasound) dataset was initially applied on state of-the art DeepLabV3 + architecture for the segmentation of breast lesions in ultrasound images. After that to focus on more informative features, a modified DeepLabV3 + has been proposed by integrating a CBAM module in encoder as well as decoder. At the end, comparative analysis of state-of-art DeepLabV3 + model and proposed modified DeepLabV3 + has also been presented in terms of performance metrics like Dice Coefficient, Intersection over Union, Precision, Recall and Specificity. The proposed model demonstrates outstanding performance across different evaluation metrics achieving precision, recall, specificity, dice coefficient and Intersection over Union (IoU) values of 0.974, 0.933, 0.997, 0.951, and 0.933. respectively.

Effect of a learning-based approach using the echo-signals obtained by a single-unit transducer on detection of breast tumors.

1566 Background: Breast cancer mortalities in the less developed countries are predicted to increase over the next decades mainly due to the low utilization rates of breast cancer screening programs. Additionally, studies have shown that the sensitivity and accuracy of breast self-examination in women are suboptimal. Therefore, it is important to develop a novel and affordable technology that can accurately detect small breast tumors in women. We have developed a deep learning-based echo- signal processing system that can detect breast tumors with high sensitivity and accuracy by merely obtaining ego-motion estimated echo-signals generated by a single-unit piezoelectric transducer system. Methods: We have prospectively collected echo-signals using a single-unit piezoelectric transducer system in 200 patients with breast tumors who underwent curative surgery at the Seoul National University Hospital and SMG-SNU Boramae Medical Center between Oct 2022 and Feb 2024. The data from the first 131 cases was used for the training and testing of the deep learning model with the ratio of 8:2, and the subsequent data from 69 cases was used for the external validation. We used ImageNet pre-trained ResNet50 model to train the deep learning model and adopted various data augmentation methods for model robustness. Five nested cross-validation was used to ensure the generalization performance. Results: The median age of the enrolled patients was 55 (IOR, 47-63) and 65 patients (32.5%) had non-palpable breast tumors. Nearly half of the patients (n=93, 46.5%) had tumors smaller than 2.0 cm in the largest dimension. Our deep learning algorithm showed outstanding performance with the area under the curve (AUC) of 0.914±0.022 and 0.964±0.011 for the image- and region-level, respectively, in the training and testing set (n=131). In the external validation set (n=69), the model demonstrated an AUC of 0.846±0.012 and 0.932±0.009 for the image- and region-level, respectively. As shown (Table), the accuracy, sensitivity, and specificity were substantially improved for the region-level analysis when compared with those of the image-level analysis. Conclusions: Using a prospectively collected data from 200 patients, we developed a highly accurate and robust deep learning model to detect breast tumors in women by processing echo-signals obtained by a single-unit piezoelectric transducer system. Our data indicate that deep learning approach based on low-volume echo signal can lead to a novel and affordable breast tumor screening strategy that can improve early breast cancer detection.[Table: see text]

Occurrence of Residual Breast Tumors and Efficacy of MRI in their Detection after Vacuum-assisted Excisional Biopsy.

Residual breast tumors may remain after vacuum-assisted excisional biopsy (VAEB). To determine the incidence of residual breast tumors in patients after VAEB and the efficacy of magnetic resonance imaging (MRI) in detecting these tumors. This retrospective analysis examined patients who received VAEB before a diagnosis of breast cancer (BC) at our hospital from 2015 to 2019. The incidence of residual tumors after VAEB was determined by MRI and pathological examination. The diagnostic value of MRI in detecting residual tumors was determined for all patients and different subgroups. Logistic regression analysis was used to identify factors associated with residual tumors. We examined 147 patients and obtained pathological samples from 146 patients, including 103 (70.5%) with residual tumors and 43 (29.5%) without residual tumors. The MRI examinations demonstrated the complete tumor resection rate was 48.9%. Compared to the pathological results, MRI had a positive predictive value of 77.8%, negative predictive value of 48.8%, specificity of 65.6%, and sensitivity of 60.7%. Further analysis indicated that MRI had moderate accuracies for patients with stage pT-1 (71.9%), stage pTNM-IA (73.1%), and luminal B subtype (78.3%). Binary logistic regression analysis showed that the risk of tumor residue correlated with the pathological stage. Tumor residue is common after VAEB, and MRI has limited accuracy in detecting these residual tumors. However, for small breast tumors and luminal B subtype BC, MRI had higher accuracy in the detection of residual tumors. The risk of tumor residue is closely associated with the pathological stage.

MR-guided percutaneous microwave coagulation of small breast tumors

BackgroundTo evaluate the technical success and patient safety of magnetic resonance-guided percutaneous microwave coagulation (MR-guided PMC) for breast malignancies.MethodsFrom May 2018 to December 2019, 26 patients with breast tumors measuring 2 cm or less were recruited to participate in a prospective, single-institution clinical study. The primary endpoint of this study was the evaluation of treatment efficacy for each patient. Histochemical staining with α-nicotinamide adenine dinucleotide and reduced (NADH)-diaphorase was used to determine cell viability following and efficacy of PMC. The complications and self-reported sensations from all patients during and after ablation were also assessed. The technical success of the PMC procedure was defined when the area of the NADH-diaphorase negative region fully covered the hematoxylin–eosin (H&E) staining region in the tumor.ResultsAll patients had a complete response to ablation with no residual carcinoma on histopathological specimen. The mean energy, ablation duration, and procedure duration per tumor were 36.0 ± 4.2 kJ, 252.9 ± 30.9 S, and 104.2 ± 13.5 min, respectively. During the ablation, 14 patients underwent prolonged ablation time, and 1 patient required adjusting of the antenna position. Eleven patients had feelings of subtle heat or swelling, and 3 patients experienced slight pain. After ablation, one patient took two painkillers because of moderate pain, and no patients had postoperative oozing or other complications after PMC. Induration around the ablation area appeared in 16 patients.ConclusionMR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future.Critical relevance statementMR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future.Key points• MR-guided PMC of small breast tumors is feasible.• PMC was successfully performed for all patients.• All patients were satisfied with the final cosmetic result.Graphical

215 (PB-122) Poster - Congruence of Tumor Characteristics between Preoperative Biopsy and Surgical Excision Specimen for Small Breast Tumors: CONSCIENCE

215 (PB-122) Poster - Congruence of Tumor Characteristics between Preoperative Biopsy and Surgical Excision Specimen for Small Breast Tumors: CONSCIENCE

Abstract P1-10-02: FLASH-RT, ultra-high dose rate rate radiotherapy, is as effective as conventional dose rate radiotherapy in eradicating tumor in a preclinical model of breast cancer

Abstract Problem Statement: Radiation therapy (RT) for breast cancer (BC) can induce skin and soft tissue fibrosis, raises concerns over cardiac and pulmonary injury, is associated with higher rates of lymphedema and shoulder dysfunction with regional nodal irradiation, and significantly increases complication rates in women undergoing implant-based reconstruction due to radiation toxicity. Although these toxicities are not generally associated with higher mortality, in general, they can represent significant setbacks with respect to quality of life. These toxicities dissuade some patients from breast conservation leading to unnecessary mastectomy and can lead patients to omit reconstruction after mastectomy or choose more extensive autologous breast reconstruction. Women with implant-based reconstruction and radiotherapy have known higher rates of reconstruction failure. Purpose: Ultra-high dose rate radiation (FLASH) has been shown to induce less normal tissue toxicity, therefore if tumor control of FLASH-RT would be comparable to conventional radiotherapy (CONV) then it has the potential to lower morbidity associated with radiotherapy for breast cancer and allow overall improved outcomes. At first, we aimed to determine the effectiveness of FLASH-RT compared to CONV in eradicating small breast tumors in an orthotopic BC model using single-fraction 20 or 30Gy RT to compare effectiveness of FLASH-RT vs CONV. Methods: Radiation sensitive, syngeneic mammary tumor cell line Py117, that efficiently forms non-metastatic orthotopic tumors in C57BL/6 mice, were injected (106 cells) into the left 4th mammary fat pad. 30mm3 tumors or a range of greater volumes (200-800mm3) were irradiated with single-fraction 20 or 30Gy with a 2x2cm radiation field (~17MeV beams), exposing only 5mm of the surrounding tissue. FLASH RT was delivered with 2Gy per pulse at dose rate ~200Gy/s compared to CONV dose rate of 0.13Gy/s Results: Single-fraction 20Gy suppressed 30mm3 tumor growth until ~day 15 post-RT then regrew for both FLASH and CONV, while 30mm3 tumors were eradicated with both FLASH and CONV at 30Gy. Larger tumors irradiated with 30Gy regressed until ~day 12 post-RT then regrew for both FLASH and CONV. There was no significant difference in growth suppression or tumor eradication between FLASH and CONV in any cohort. Conclusion: In this murine model of breast cancer, FLASH is as effective as CONV in controlling tumor growth. Future studies will extend the evaluation of the tumor control using clinically relevant fractionated dose schedules to be followed by comparisons of tumor control in xenograft models. Additional studies will assess normal tissue toxicity of FLASH vs CONV in murine models of implant-based breast reconstruction. We have established collaborations to understand differences in molecular pathways activated by FLASH vs CONV in tumor and normal tissue to explain the observed experimental differences in normal tissue, tumor, and cancer stem cells. Citation Format: Frederick Dirbas, Stavros Melemenidis, Bill Loo, Kathleen Horst, Edward E. Graves, Suparna Dutt, Vignesh Viswanathan, Brianna Lau, Amy Yu. FLASH-RT, ultra-high dose rate rate radiotherapy, is as effective as conventional dose rate radiotherapy in eradicating tumor in a preclinical model of breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-02.

ESTAN: Enhanced Small Tumor-Aware Network for Breast Ultrasound Image Segmentation.

Breast tumor segmentation is a critical task in computer-aided diagnosis (CAD) systems for breast cancer detection because accurate tumor size, shape, and location are important for further tumor quantification and classification. However, segmenting small tumors in ultrasound images is challenging due to the speckle noise, varying tumor shapes and sizes among patients, and the existence of tumor-like image regions. Recently, deep learning-based approaches have achieved great success in biomedical image analysis, but current state-of-the-art approaches achieve poor performance for segmenting small breast tumors. In this paper, we propose a novel deep neural network architecture, namely the Enhanced Small Tumor-Aware Network (ESTAN), to accurately and robustly segment breast tumors. The Enhanced Small Tumor-Aware Network introduces two encoders to extract and fuse image context information at different scales, and utilizes row-column-wise kernels to adapt to the breast anatomy. We compare ESTAN and nine state-of-the-art approaches using seven quantitative metrics on three public breast ultrasound datasets, i.e., BUSIS, Dataset B, and BUSI. The results demonstrate that the proposed approach achieves the best overall performance and outperforms all other approaches on small tumor segmentation. Specifically, the Dice similarity coefficient (DSC) of ESTAN on the three datasets is 0.92, 0.82, and 0.78, respectively; and the DSC of ESTAN on the three datasets of small tumors is 0.89, 0.80, and 0.81, respectively.

Is repeat breast conservation possible for small ipsilateral breast cancer recurrence?

Most cases of ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) involve small tumors. Although a few guidelines recommend mastectomy, several patients prefer repeat BCS (re-BCS). This study aimed to compare re-BCS and mastectomy in terms of prognosis in patients with IBTR and to identify candidates for re-BCS. The data of patients with small IBTR between 1999 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database. The outcomes of interest were overall survival (OS) and breast cancer-specific survival (BCSS). Multivariable Cox proportional hazards regression models and propensity score matching were applied. Of the 3648 patients with IBTR, 2831 (77.6%) underwent mastectomy and 817 (22.4%) underwent re-BCS. The multivariate Cox model showed that re-BCS was associated with a worse OS (hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.084-1.663) and BCSS (HR, 1.454; 95% CI, 1.004-2.105) compared with mastectomy. The omission of radiation after re-BCS was associated with worse survival overall and especially in patients with estrogen receptor (ER)-negative IBTR (HR, 1.384; 95% CI, 1.110-1.724; and HR, 1.577; 95% CI, 1.075-2.314, respectively). No statistically significant differences were observed in the OS and BCSS between re-BCS with radiation and mastectomy. Subgroup analysis indicated that the surgical approach was not an independent factor for survival in the ER-positive patients with IBTR. Re-BCS should be considered with caution in patients with small IBTR. However, a positive ER status can be an important factor for choosing re-BCS, and radiation therapy may improve oncological safety after re-BCS. Repeat breast-conserving surgery (re-BCS) was investigated to determine if it is safe for patients with small ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS). This population-based cohort study included 2831 patients with small IBTR. Re-BCS was associated with a worse overall survival and breast cancer-specific survival compared with mastectomy. Further analysis found that the IBTR estrogen receptor status was an important basis for choosing re-BCS, and radiation may improve oncological safety after re-BCS.

Correlation of breast cancer microcirculation construction with tumor stem cells (CSCs) and epithelial-mesenchymal transition (EMT) based on contrast-enhanced ultrasound (CEUS).

This study is to explore the correlation between the contrast-enhanced ultrasound (CEUS) characteristics of breast cancer and the epithelial-mesenchyme transformation (EMT). Totally 119 patients of breast cancer underwent CEUS. Tissues in the active area were collected and subjected to the immunohistochemical detection, PT-PCR and Western blot. Correlation analysis was conducted between the clinical pathological parameters and the CEUS indicators. The expression levels of CD44, N-cadherin, and β-catenin in breast cancer tissues were higher than those in adjacent tissues (P<0.05). However, the expression levels of CD24 and E-cadherin in breast cancer tissues were lower than those in adjacent tissues (P<0.05). There was no significant difference in E-cadherin mRNA and Vimentin levels between cancer and adjacent tissues (P>0.05). The expressions were up-regulated in the CSCs, with higher histological grade, lymph node metastasis, and negative estrogen receptor (ER) expression. Smaller breast tumors, with no lymph node metastasis, lower clinical stage, and positive ER expression, tended to exhibit the up-regulated epithelial phenotype. Breast tumors, with high histological grade, lymph node metastasis, high clinical staging grade, and negative ER expression, tended to exhibit the up-regulated interstitial phenotype. The peak intensity of the time-intensity curve (TIC) for the CEUS was positively correlated with the CSC marker CD44 and the interstitial phenotype marker N-cadherin. The starting time of enhancement was negatively correlated with the N-cadherin. Area under the curve was positively correlated with the expression of CD44 and N-cadherin, while negatively correlated with the epithelial phenotype marker β-catenin. The time to peak was negatively correlated with the interstitial phenotypes Vimentin and N-cadherin, with no correlation with the E-cadherin or β-catenin. Breast cancers show the enlarged lesions after enlargement and perfusion defect for the CEUS. The fast-in pattern, high enhancement, and high perfusion in the TIC are correlated with the CSCs and EMT expressions, suggesting poor disease prognosis.

An Excitation-Reception Collinear Probe for Ultrasonic, Photoacoustic, and Thermoacoustic Tri-Modal Volumetric Imaging.

Imaging systems that integrate multiple modalities can reveal complementary anatomic and functional information as they exploit different contrast mechanisms, which have shown great application potential and advantages in preclinical studies. A portable and easy-to-use imaging probe will be more conducive to transfer to clinical practice. Here, we present a tri-modal ultrasonic (US), photoacoustic (PA), and thermoacoustic (TA) imaging system with an excitation-reception collinear probe. The acoustic field, light field, and electric field of the probe were designed to be coaxial, realizing homogeneous illumination and high-sensitivity detection at the same detection position. US images can provide detailed information about structures, PA images can delineate the morphology of blood vessels in tissues, and TA images can reveal dielectric properties of the tissues. Moreover, phantoms and in vivo human finger experiments were performed by the tri-modal imaging system to demonstrate its performance. The results show that the tri-modal imaging system with the proposed probe has the ability to detect small breast tumors with a radius of only 2.5 mm and visualize the anatomical structure of the finger in three dimensions. Our work confirms that the tri-modal imaging system equipped with a collinear probe can be applied to a variety of different scenarios, which lays a solid foundation for the application of the tri-modality system in clinical trials.

Assessment of Tumor Cell Death After Percutaneous Ultrasound– Guided Radiofrequency Ablation of Breast Carcinoma: A Prospective Study

Background: Current trends in breast cancer treatment include the use of less aggressive surgeries to reduce morbidity, shorten hospital stays and improve cosmetic results. The aim of the study is to assess tumor cell viability after percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for small breast cancer by a combination of staining techniques. Methods: A prospective study was conducted at a single institution from 2013 to 2017. Twenty women with invasive ductal carcinoma of the breast measuring ≤ 20 mm were treated with US-guided RFA followed immediately by surgical resection. Tumor viability pre- and post-RFA was assessed with Hematoxylin and Eosin (H&amp;E), Nicotinamide adenine dinucleotide (NADH), Succinate dehydrogenase (SDH), Cytochrome c oxidase (COX), Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Cytokeratin 18 and 19 (CK18/CK19) staining techniques. Outcomes and correlation with the different techniques were evaluated with principal component analysis Cronbach’s alpha. Results: Oxidative enzymes in frozen sections showed loss of SDH and NADH in 13 of the 16 tumors (81%) and COX in 11 of the 13 tumors (84%). In paraffin-embedded tissues, CK18 was negative or markedly reduced in 98% and CK19 in 100% of the cases. Lack of evidence of cell death was seen in 3 cases where the maximum temperature achieved at the center of the tumor was ≤ 70ºC. The reliability and internal consistency between the different staining techniques was high (Cronbach’s alpha, 0.8), with concordance between the staining results of the oxidative enzymes and of CK18/CK19. Conclusion: Loss of tumor viability in small breast tumors after US-guided percutaneous RFA could be assessed in our series with different staining methods. CK18 and CK19 could be used in paraffin-embedded tissues as surrogate markers of tumor cell viability after immediate RFA.

In modern times, how important are breast cancer stage, grade and receptor subtype for survival: a population-based cohort study

BackgroundIn breast cancer, immunohistochemistry (IHC) subtypes, together with grade and stage, are well-known independent predictors of breast cancer death. Given the immense changes in breast cancer treatment and survival over time, we used recent population-based data to test the combined influence of IHC subtypes, grade and stage on breast cancer death.MethodsWe identified 24,137 women with invasive breast cancer aged 20 to 74 between 2005 and 2015 in the database of the Cancer Registry of Norway. Kaplan-Meier curves, mortality rates and adjusted hazard ratios for breast cancer death were estimated by IHC subtypes, grade, tumour size and nodal status during 13 years of follow-up.ResultsWithin all IHC subtypes, grade, tumour size and nodal status were independent predictors of breast cancer death. When combining all prognostic factors, the risk of death was 20- to 40-fold higher in the worst groups compared to the group with the smallest size, low grade and ER+PR+HER2− status. Among node-negative ER+HER2− tumours, larger size conferred a significantly increased breast cancer mortality. ER+PR−HER2− tumours of high grade and advanced stage showed particularly high breast cancer mortality similar to TNBC. When examining early versus late mortality, grade, size and nodal status explained most of the late (> 5 years) mortality among ER+ subtypes.ConclusionsThere is a wide range of risks of dying from breast cancer, also across small breast tumours of low/intermediate grade, and among node-negative tumours. Thus, even with modern breast cancer treatment, stage, grade and molecular subtype (reflected by IHC subtypes) matter for prognosis.

Efficient focusing of microwave hyperthermia for small deep-seated breast tumors treatment using particle swarm optimization

Focused microwave hyperthermia is a technique with advantage of high accuracy and low side effects for breast tumor treatments. In this study, an efficient focusing technique for noninvasive microwave hyperthermia treatment for breast tumors is presented. Particle Swarm Optimization (PSO) is used to find the optimum excitations (phases and amplitudes) of a three dimension (3D) Micro-Strip Patch (MSP) antenna array operating at 2.45 GHz. The antenna excitations are optimized to maximize the power loss density and the Specific Absorption Rate (SAR) at the tumor location, to reach the required hyperthermia temperature (above 42 °C) at the tumor location without causing hot spots in healthy tissues. The technique is tested on a challenging scenario of a 3D realistic breast model having a tumor less than 1 cm3 volume and embedded in different locations deep in the glandular tissue of a very dense breast. The results confirmed the capability of the focusing technique.

Breast Cancer-Specific Mortality in Small-Sized Tumor with Stage IV Breast Cancer: A Population-Based Study.

Small-sized primary tumor does not always indicate a better prognosis. We hypothesized that very small primary breast tumors with extensive lymph node (LN) metastases represented an aggressive biologic behavior in stage IV disease. Data between 2010 and 2015 were retrieved retrospectively from the Surveillance, Epidemiology, and End Results database with inclusion criteria of female sex, unilateral, metastatic, and T1/2 invasive ductal carcinoma. Primary study variables included T stage, N stage, grade, metastatic sites, number of involved sites, estrogen receptor status, progesterone receptor status, and human epidermal growth factor receptor 2 status. Kaplan-Meier and adjusted Cox proportional hazards models with interaction terms were used. One-, 2- and 3-year breast cancer-specific mortality (BCSM) was examined according to tumor size. We identified 5,340 eligible patients with breast cancer. In multivariate analysis, race, age, grade, molecular subtype, surgery, brain metastases, and liver metastases were found to be independently associated with BCSM. For T1 tumors, the N0, N1, and N2+ groups had the same BCSM. In tumors smaller than 50 mm, the 1-, 2-, and 3-year BCSM did not decline with the decrease of tumor size. For triple-negative breast cancers (TNBCs), the T1a/T1bN2+ group had significantly worse BCSM than any other group did. Patients with stage IV cancer with small-sized tumors may have BCSM as high as those with larger tumors. In TNBCs, very small tumors with severe LN involvement are associated with the worst BCSM. Continued efforts are needed to further investigate Ta1/T1bN2 + M1 TNBCs and individualize the treatment for affected patients. This study revealed that for stage IV breast cancer, smaller primary tumors were not always associated with better breast cancer-specific mortality. This study illustrated that very small triple-negative breast cancers (TNBCs) with extensive regional lymph node involvement may be a surrogate for biologically aggressive disease. Because of poor prognosis of T1a/T1bN2+ TNBCs, there might be an urgent need of more individualized treatment for affected patients. Future correlative studies ought to focus on the genetic and molecular differences in Ta1/T1bN2+ TNBCs that contribute to the biological behavior. Clarification of the regulation mechanism of very small-sized primary TNBCs with metastatic outgrowth in nodes and distant sites will play an integral role in developing targeted therapies.

The Chicago Consensus on peritoneal surface malignancies: Management of desmoplastic small round cell tumor, breast, and gastrointestinal stromal tumors.

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of desmoplastic small round cell, breast, and gastrointestinal stromal tumors specifically related to peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

The Chicago Consensus on Peritoneal Surface Malignancies: Management of Desmoplastic Small Round Cell Tumor, Breast, and Gastrointestinal Stromal Tumors.

The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of desmoplastic small round cell tumor, breast, and gastrointestinal stromal tumor specifically related to peritoneal surface malignancy. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.

STAN: SMALL TUMOR-AWARE NETWORK FOR BREAST ULTRASOUND IMAGE SEGMENTATION.

Breast tumor segmentation provides accurate tumor boundary, and serves as a key step toward further cancer quantification. Although deep learning-based approaches have been proposed and achieved promising results, existing approaches have difficulty in detecting small breast tumors. The capacity to detecting small tumors is particularly important in finding early stage cancers using computer-aided diagnosis (CAD) systems. In this paper, we propose a novel deep learning architecture called Small Tumor-Aware Network (STAN), to improve the performance of segmenting tumors with different size. The new architecture integrates both rich context information and high-resolution image features. We validate the proposed approach using seven quantitative metrics on two public breast ultrasound datasets. The proposed approach outperformed the state-of-the-art approaches in segmenting small breast tumors.

Characterization of a Molecular Breast Imaging system in Limited Angle Tomography using a dedicated breast phantom

This work reports on the Limited Angle Tomography (LAT) studies of a novel Molecular Breast Imaging (MBI) system with radionuclides, made by two asymmetric SPECT-like detector heads with two different optics. MBI has a central role to play in detecting the small breast tumours, especially for dense breasts, due to its specificity in detecting tumours even in dense breasts. For this purpose, an innovative device has been developed at ISS in Rome, composed of a dual detector setup which combines images from two complementary detectors at the opposite sides of the compressed breast, and that allows spot compression and LAT for a tumour 3-D reconstruction. Our study tries to demonstrate the feasibility of using this novel system in LAT , where a small detector head with pinhole collimator is able to rotate around the breast phantom, to diagnose the small tumours and to improve the sensitivity and efficiency. Detector heads and phantom, LAT setup and first preliminary results, are presented.

Estrogens and Glucocorticoids in Mammary Adipose Tissue: Relationships with Body Mass Index and Breast Cancer Features

ContextAdipose tissue is an important site for extragonadal steroid hormone biosynthesis through the expression and activity of P450 aromatase, 11β-hydroxysteroid dehydrogenase (HSD) 1, and 17β-HSDs. The contribution of steroid hormones produced by adjacent adipose tissue for the progression and survival of breast tumors is unknown.ObjectiveTo quantify estrogens (estradiol, estrone) and glucocorticoids (cortisol, cortisone) in breast adipose tissue from both healthy and diseased women and their relationships with adiposity indices and breast cancer prognostic markers.Design and settingBreast adipose tissue was collected at time of surgery.PatientsPre- and postmenopausal women undergoing partial mastectomy for treatment of breast cancer (n = 17) or reduction mammoplasty (n = 6) were studied.InterventionsRelative estrogen and glucocorticoid amounts were determined by liquid chromatography tandem mass spectrometry.ResultsThe targeted steroids were reliably detected and quantified in mammary adipose tissues. Women with ER+/PR+ tumor had higher relative estradiol amount than women with ER–/PR– tumor (P < .05). The ratio of estradiol-to-estrone was higher in lean women than in women with a body mass index (BMI) ≥ 25 kg/m2 (P < .05). Mixed-model analyses showed that estradiol, cortisone, and cortisol were negatively associated with tumor size (P < .05). Relationships between glucocorticoids and tumor size remained significant after adjustment for BMI. The cortisol-to-cortisone ratio was negatively associated with tumor stage (P < .05) independently of BMI.ConclusionsWe reliably quantified estrogens and glucocorticoids in breast adipose tissue from healthy women and women suffering from breast cancer. Our findings suggest that smaller breast tumors are associated with higher relative amounts of estradiol and cortisol in adipose tissue.

Detection of Breast Cancer Recurrence by Using Positron Emission Tomography with 18 Fluorodeoxyglucose (FDG-PET)-Computed Tomography (CT) and Tumor Markers

Abstract Background: Breast cancer is responsible for nearly 15% of death in female cancer related death in western countries and is cosidered the second leading cause to death due to cancer in females. In Egypt, it is the most common cancer in female, representing about 38.8% of total cancer cases in women. Early diagnosis of recurrent breast cancer is crucial to selection of the most appropriate therapy. FDG-PET/CT has been used for diagnosis, staging, monitoring response to therapy, and restaging patients with breast cancer. Although FDG-PET/CT may have limited diagnostic value in detecting small primary breast tumors, in staging of the axillary region, and in detecting osteoblastic metastases, it is superior to conventional imaging modalities in detecting distant metastases and in monitoring response to therapy. Aim of Study: To evaluate the role of PET/CT and tumor markers in detection of breast cancer recurrence in Clinical Radio-Diagnosis Department. Patients and Methods: Twenty five female patients their age was from 22-67 years (mean 43 years) all with breast cancer history and elevated serum tumor markers after their initial diagnosis were retrospectively evaluated. PET/CT results were confirmed by further imaging, and follow-up. Changes in further management based on PET/CT were recorded. Results: The patients' age was from 22-67 years. Most of them were (60%) were premenopausal. In this study, 92% had Infiltrating Ductal Carcinoma (IDC) while only 2 patients (8%) had Infiltrating Lobular Carcinoma (ILC), fourteen patients (56%) had recurrence of tumor, and 11 (44%) patients showed no further evidence of disease. Fourteen patients had abnormal PET/CT studies, and 11 patients had normal studies with an overall sensitivity, specificity, and accuracy of 85.7%, 81.8%, and 84%, respectively. PET/CT was compared with contrast-enhanced CT and had a higher sensitivity (85.7% vs. 71.4%), specificity (81.8% vs. 45.4%), and accuracy (84% vs. 60%). PET/CT was also compared with tumor markers and had a higher sensitivity (85.7% vs. 78.5%), specificity (81.8% vs. 18.1%), and accuracy (84% vs. 52%).Conclusion: FDG-PET/CT was superior to conventional imaging modalities in diagnosis of breast cancer recurrence.