Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.

Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases

The upsurge in the need of targeted controlled drug delivery (TCDD) has led to the invention of remarkable biomaterials with improved biocompatibility and biodegradability. In recent years, "Smart Polymers" have emerged as a potential candidate, competing with the existing hydrogel systems used for controlled drug delivery. This article is an effort to highlight the diverse applications of hydrogels for revolutionizing the present research on drug delivery systems. This article summarizes the role of hydrogels as delivery vehicles for drugs used in various disorders related to the brain and other distinct parts of the human body. The clinical application and toxicological aspects of hydrogels are also highlighted. Their potential for diagnostics and various therapeutic interventions against tuberculosis have been reviewed. In addition, the limitations and future prospectives in the development of biopolymeric hydrogels are discussed.

Recent advances in hydrogel based drug delivery systems for the human body

Diffusion-weighted MRI (DWI) holds potential to improve the detection and biological characterization of breast cancer. DWI is increasingly being incorporated into breast MRI protocols to address some of the shortcomings of routine clinical breast MRI. Potential benefits include improved differentiation of benign and malignant breast lesions, assessment and prediction of therapeutic efficacy, and noncontrast detection of breast cancer. The breast presents a unique imaging environment with significant physiologic and inter-subject variations, as well as specific challenges to achieving reliable high quality diffusion-weighted MR images. Technical innovations are helping to overcome many of the image quality issues that have limited widespread use of DWI for breast imaging. Advanced modeling approaches to further characterize tissue perfusion, complexity, and glandular organization may expand knowledge and yield improved diagnostic tools.

Level of Evidence: 5

J. Magn. Reson. Imaging 2016

/pdf/diffusion-weighted-breast-mri-clinical-applications-and-1mmrs6cbdp.pdf

Diffusion-weighted breast MRI: Clinical applications and emerging techniques

Objective
We evaluated whether the apparent diffusion coefficient (ADC) provided by diffusion-weighted imaging (DWI) varies according to biological features in breast cancer.

Correlations between diffusion-weighted imaging and breast cancer biomarkers

Diffusion-weighted imaging provides a novel contrast mechanism in magnetic resonance (MR) imaging and has a high sensitivity in the detection of changes in the local biologic environment. A significant advantage of diffusion-weighted MR imaging over conventional contrast material-enhanced MR imaging is its high sensitivity to change in the microscopic cellular environment without the need for intravenous contrast material injection. Approaches to the assessment of diffusion-weighted breast imaging findings include assessment of these data alone and interpretation of the data in conjunction with T2-weighted imaging findings. In addition, the analysis of apparent diffusion coefficient (ADC) value can be undertaken either in isolation or in combination with diffusion-weighted and T2-weighted imaging. Most previous studies have evaluated ADC value alone; however, overlap in the ADC values of malignant and benign disease has been observed. This overlap may be partly due to selection of b value, which can influence the concomitant effect of perfusion and emphasize the contribution of multicomponent model influences. The simultaneous assessment of diffusion-weighted and T2-weighted imaging data and ADC value has the potential to improve specificity. In addition, the use of diffusion-weighted imaging in a standard breast MR imaging protocol may heighten sensitivity and thereby improve diagnostic accuracy. Standardization of diffusion-weighted imaging parameters is needed to allow comparison of multicenter studies and assessment of the clinical utility of diffusion-weighted imaging and ADC values in breast evaluation.

https://pubs.rsna.org/doi/pdf/10.1148/rg.314105160

Diffusion-weighted Imaging of the Breast: Principles and Clinical Applications

Purpose

To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors.



Materials and Methods

Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test.



Results

DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 ± 0.27 × 10−5 mm2/s) and normal parenchyma (1.59 ± 0.27 × 10−5 mm2/s) was detected (P < 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 × 10−5 mm2/s versus 1.15 × 10−5 mm2/s, P = 0.053).



Conclusion

The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis. J. Magn. Reson. Imaging 2009;30:615–620. © 2009 Wiley-Liss, Inc.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.21884

Diffusion‐weighted imaging of breast cancer: Correlation of the apparent diffusion coefficient value with prognostic factors

Objectives
The purpose of this study was to evaluate the diagnostic utility of sonographic elastography in differentiating reactive and metastatic axillary lymph nodes in breast cancer.

Methods
A total of 64 lymph nodes (reactive, n = 33; metastatic, n = 31) from 62 patients with breast cancer were examined by both B-mode sonography and elastography from April to July 2009. Two experienced radiologists retrospectively assessed B-mode sonograms by the sum of scores for 4 criteria: short diameter, shape, hilum, and cortical thickening. Elastographic images were given scores of 1 to 4 according to the percentage of high-elasticity areas in the lymph nodes. We compared the diagnostic performance of B-mode sonography, elastography, and combined examinations. We also calculated the strain ratio of the lymph node and subcutaneous fat tissue.

Results
The elasticity score for malignant lymph nodes (mean, 3.1) was higher than the score for benign lymph nodes (mean, 2.2; P < .0001). With a cutoff between elasticity scores of 2 and 3, elastography showed 80.7% sensitivity, 66.7% specificity, and 73.4% accuracy. With a cutoff between B-mode sonographic scores of 1 and 2, B-mode sonography showed 74.2% sensitivity and 78.8% specificity. Combined B-mode and elastographic sonography showed higher sensitivity (87.1%) than B-mode sonography alone. With a strain ratio cutoff point of 2.3, sensitivity was 82.8%, and specificity was 56.3%.

Conclusions
Sonographic elastography may increase the sensitivity of B-mode sonography in the detection of metastatic axillary lymph nodes.

https://onlinelibrary.wiley.com/doi/pdf/10.7863/jum.2011.30.4.429

Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer

Role and clinical usefulness of elastography in small breast masses.

Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI.

OBJECTIVE. The purpose of this study was to determine the clinical significance of the incidental finding of hypermetabolic foci in the breast at 18F-FDG PET/CT in patients with malignant disease other than breast cancer or during a screening examination. MATERIALS AND METHODS. The files of 13,897 women who underwent FDG PET/CT from November 2004 to October 2009 were retrospectively reviewed. Forty-eight patients with incidental breast uptake had undergone either tissue confirmation or clinical follow-up with additional sonographic imaging. The following four variables were evaluated: age, maximum standard uptake value (SUVmax) of breast uptake at FDG PET, findings in the CT portion of PET/CT, and sonographic findings. Malignancy rates were calculated for each variable. RESULTS. Malignancy was diagnosed in 18 (37.5%) patients and a benign condition in 30 (62.5%) patients. Statistically significant differences in malignancy rate were found between the groups with SUVmax less than 2 (24.2%) and the group wi...

Jae Jeong Choi

Papers

Diffusion‐weighted imaging of breast cancer: Correlation of the apparent diffusion coefficient value with prognostic factors

Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer

Role and clinical usefulness of elastography in small breast masses.

Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI.

Clinical Significance of Incidental Finding of Focal Activity in the Breast at 18F-FDG PET/CT