Identification of Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Breast Cancer: A Retrospective Study

Objective: To determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer. Materials and Methods: We reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27-79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins. Results: In univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076). Conclusion: Non-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.ope

Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels

OBJECTIVE: To validate preoperative dynamic CT and fecal elastase-1 level in predicting the development of pancreatic fistulae after pancreatoduodenectomy. MATERIALS AND METHODS: For 146 consecutive patients, CT attenuation values of the nontumorous pancreatic parenchyma were retrospectively measured on precontrast, arterial and equilibrium phase images for calculation of enhancement ratios. CT enhancement ratios and preoperative fecal elastase-1 levels were correlated with the development of pancreatic fistulae using independent t-test, logistic regression models, ROC analysis, Youden method and tree analysis. RESULTS: The mean value of enhancement ratio on equilibrium phase was significantly higher (p = 0.001) in the patients without pancreatic fistula (n = 107; 2.26±3.63) than in the patients with pancreatic fistula (n = 39; 1.04±0.51); in the logistic regression analyses, it was significant predictor for the development of pancreatic fistulae (odds ratio = 0.243, p = 0.002). The mean preoperative fecal elastase-1 levels were higher (odds ratio = 1.003, p = 0.034) in the pancreatic fistula patients than other patients, but there were no significant differences in the areas under the curve between the prediction values of CT enhancement ratios and fecal elastase-1 combined and those of CT enhancement ratios alone (P = 0.897, p = 0.917) on ROC curve analysis. Tree analysis revealed that the CT enhancement ratio was more powerful predictor of pancreatic fistula than fecal elastase-1 levels. CONCLUSION: The preoperative CT enhancement ratio of pancreas acquired at equilibrium phase regardless of combination with fecal elastase-1 levels might be a useful predictor of the risk of developing a pancreatic fistula following pancreatoduodenectomy.ope

Comparison of the diagnostic performances of ultrasonography, CT and fine needle aspiration cytology for the prediction of lymph node metastasis in patients with lymph node dissection of papillary thyroid carcinoma: A retrospective cohort study

PURPOSE: To evaluate the diagnostic performances of ultrasonographic (US) findings, computed tomography (CT) findings and fine needle aspiration cytology (FNAC) for the prediction of cervical lymph node (LN) metastases of papillary thyroid carcinoma (PTC) to determine which LN should be dissected. METHODS: 376 LNs in 302 patients who underwent both US-guided skin surface LN markings and CT before LN dissection were analyzed retrospectively. Indications for LN dissection were suspicious US findings of LN metastases (n=300), suspicious CT findings (n=67) or surgeon's request (n=9). Diagnostic performances of US, CT and FNAC (including thyroglobulin (Tg)) were evaluated. The correlations of suspicious US, CT finding or malignant FNAC with the size, number and the presence of extranodal extension of metastatic LNs were analyzed. RESULTS: US indication of LN dissection was significantly correlated with malignancy (p < .0001). Values of area under the curve of highly suspicious US findings and FNAC+Tg were significantly higher than that of CT (0.786, 0.878, 0.585, p < .0001, respectively). Suspicious US, CT findings and malignant FNAC+Tg were significantly associated with the largest size of metastatic LNs (p = .003, p = .0003, and p = .0006, respectively) and total number of metastatic LNs (p = .007, p = .038, and p = .005, respectively). CONCLUSION: The diagnostic performance of US or FNAC was superior to CT and highly suspicious US findings could be complimentary to FNAC results in predicting LN metastases of PTC. LN dissection should be performed for the LNs with any suspicious US findings or malignant FNAC results rather than LNs with only suspicious CT findings.restrictio