Breast cancer MR deep radiomics in prediction of molecular receptors status

Breast cancer is the first leading cause of mortality among women in the world. The knowledge of the presence or absence of specific molecular receptors in the tumor such as the estrogen receptor (ER), the progesterone receptor (PR) and the human epidermal growth factor receptor 2 (HER2), is fundamental in order to set up a personalized therapy. Radiomic is an interesting field of study allowing to extract and analyze, starting from biomedical images, data that can provide decision support in clinical practice. The aim of our study was to verify if there are radiomic features able to predict, starting from magnetic resonance images, the state of the hormone receptors of the breast tumors analyzed in order to support the decision-making and therapeutic process. The population of this study is composed of 100 patients having breast cancer subjected to magnetic resonance enhanced by dynamic contrast (DCE-MRI) at our center. All tumors were confirmed by a biopsy and an immunohistochemical analysis was performed for each of them. A radiologist using QUIBIM PRECISION ® 2.3, identified, for each lesion, a region of interest and segmented it manually. By the information contained in the segmented ROIs were extracted 29 radiomic features. Binary logistic model and Artificial Neural Networks (ANN) technology were used to analyze the features. Diagnostic accuracy (sensitivity and specificity) obtained with ANN seems to be better than binary logistic model (based on four features as Auto Correlation Value, Sum Average Value, Gray Level Standard Deviation and D3D Value)

Sviluppo di impegno d'organo de novo durante il follow-up nel Morbo di Behcet: analisi di una casistica monocentrica

Il Morbo di Behçet (MB) è una vasculite multisistemica cronica recidivante che colpisce i piccoli e grandi vasi dei sistemi venosi e arteriosi. In genere è caratterizzata da ulcere oro-genitali ricorrenti, infiammazioni oculari e manifestazioni cutanee; può verificarsi anche un coinvolgimento articolare, vascolare, gastroenterico e neurologico. Obiettivi: L'obiettivo primario dello studio è stato quello di valutare l'incidenza dell’ impegno d’organo de novo durante il follow-up in una coorte di pazienti con Morbo di Behçet (BS); l'obiettivo secondario quello di analizzare il profilo epidemiologico e la prognosi a lungo termine dei pazienti che hanno sviluppato un nuovo impegno degli organi principali. Metodi: Tra la nostra coorte di 120 pazienti con MB, abbiamo valutato tutti i soggetti che non avevano alcun coinvolgimento degli organi principali durante i primi anni della loro malattia; in particolare, all'esordio della patologia, il 52% della coorte (n = 62) ha presentato un coinvolgimento muco-cutaneo diffuso. Gli outcome primari erano rappresentati da: 1. l'incidenza dell’impegno d’organo de novo durante il follow-up; 2. l'uso di farmaci immunosoppressori durante il follow-up. Abbiamo definito lo sviluppo di un impegno d’organo de novo durante il follow-up, come la comparsa di un coinvolgimento oculare grave (uveite anteriore, uveite posteriore e vasculite retinica), di un impegno vascolare (trombosi venosa profonda, trombosi venosa superficiale, trombosi arteriosa, ed aneurismi arteriosi) o del sistema nervoso centrale (SNC) (lesioni ischemiche ponto-mesencefaliche e meningoencefalite) dopo un periodo di latenza di almeno 3 anni dalla diagnosi. Risultati: tra i 62 pazienti caratterizzati da un inizio lieve della malattia, abbiamo osservato che dopo almeno 3 anni dalla diagnosi, 21 pazienti con MB (34%) hanno sviluppato gravi patologie. In particolare, 3 pazienti hanno avuto un coinvolgimento oculare, 9 pazienti un impegno neurologico ed altri 9 pazienti hanno presentato un coinvolgimento vascolare. Confrontando i principali risultati epidemiologici e clinici dei due gruppi, abbiamo osservato che i pazienti che hanno sviluppato un coinvolgimento degli organi principali de novo, erano più frequentemente giovani maschi; Inoltre, il 95% di questi pazienti si contraddistingue per l’insorgenza della malattia in giovane età (p <0.001). Conclusioni: L’essere liberi da complicanze degli organi principali nei primi anni di malattia non è necessariamente un fattore prognostico favorevole. Globalmente, lo sviluppo di un impegno d’organo de novo nel corso del MB suggerisce che uno stretto controllo è fortemente raccomandato durante il decorso della malattia

Development of de novo major involvement during follow-up in Behçet's syndrome

The primary aim of the study was to evaluate the incidence of de novo major involvement during follow-up in a cohort of patients with Behçet's syndrome (BS); the secondary aim was to analyse the epidemiological profile and the long-term outcome of those patients who developed new major involvement. Among our cohort of 120 BS patients, we evaluated all subjects who had no major organ involvement during the early years of their disease; specifically, at disease onset, the 52 % of the cohort presented a prevalent mucocutaneous involvement. The primary outcomes were represented by the following: Hatemi et al. (Rheum Dis Clin North Am 39(2):245-61, 2013) the incidence of de novo major involvement during the follow-up and Hatemi et al. (Clin Exp Rheumatol 32(4 Suppl 84):S112-22, 2014) the use of immunosuppressive drugs during the follow-up. We have defined the development of de novo major involvement during the follow-up as the occurrence of severe ocular, vascular or CNS involvement after a latency period from the diagnosis of at least 3 years. Among 62 patients characterized by a mild onset of disease, we observed that after at least 3 years from the diagnosis, 21 BS patients (34 %) still developed serious morbidities. Specifically, three patients developed ocular involvement, nine patients developed neurological involvement and nine patients presented vascular involvement. Comparing main epidemiological and clinical findings of the two groups, we observed that patients who developed de novo major involvement were more frequently males and younger; furthermore, 95 % of these patients were characterized by a young onset of disease (p < 0.001). Being free of major organ complication in the first years of BS is not necessary a sign of a favourable outcome. Globally, the development of de novo major involvement during the coursfce of BS suggests that a tight control is strongly recommended during the course of the disease

Radiomic Applications on Digital Breast Tomosynthesis of BI-RADS Category 4 Calcifications Sent for Vacuum-Assisted Breast Biopsy

Background: A fair amount of microcalcifications sent for biopsy are false positives. The study investigates whether quantitative radiomic features extracted from digital breast tomosynthesis (DBT) can be an additional and useful tool to discriminate between benign and malignant BI-RADS category 4 microcalcification. Methods: This retrospective study included 252 female patients with BI-RADS category 4 microcalcifications. The patients were divided into two groups according to micro-histopathology: 126 patients with benign lesions and 126 patients with certain or possible malignancies. A total of 91 radiomic features were extracted for each patient, and the 12 most representative features were selected by using the agglomerative hierarchical clustering method. The binary classification task of the two groups was carried out by using four different machine-learning algorithms (i.e., linear support vector machine (SVM), radial basis function (RBF) SVM, logistic regression (LR), and random forest (RF)). Accuracy, sensitivity, sensibility, and the area under the curve (AUC) were calculated for each of them. Results: The best performance was achieved using the RF classifier (AUC = 0.59, 95% confidence interval 0.57&ndash;0.60; sensitivity = 0.56, 95% CI 0.54&ndash;0.58; specificity = 0.61, 95% CI 0.59&ndash;0.63; accuracy = 0.58, 95% CI 0.57&ndash;0.59). Conclusions: DBT-based radiomic analysis seems to have only limited potential in discriminating benign from malignant microcalcifications

Radiomic Applications on Digital Breast Tomosynthesis of BI-RADS Category 4 Calcifications Sent for Vacuum-Assisted Breast Biopsy

Background: A fair amount of microcalcifications sent for biopsy are false positives. The study investigates whether quantitative radiomic features extracted from digital breast tomosynthesis (DBT) can be an additional and useful tool to discriminate between benign and malignant BI-RADS category 4 microcalcification. Methods: This retrospective study included 252 female patients with BI-RADS category 4 microcalcifications. The patients were divided into two groups according to micro-histopathology: 126 patients with benign lesions and 126 patients with certain or possible malignancies. A total of 91 radiomic features were extracted for each patient, and the 12 most representative features were selected by using the agglomerative hierarchical clustering method. The binary classification task of the two groups was carried out by using four different machine-learning algorithms (i.e., linear support vector machine (SVM), radial basis function (RBF) SVM, logistic regression (LR), and random forest (RF)). Accuracy, sensitivity, sensibility, and the area under the curve (AUC) were calculated for each of them. Results: The best performance was achieved using the RF classifier (AUC = 0.59, 95% confidence interval 0.57–0.60; sensitivity = 0.56, 95% CI 0.54–0.58; specificity = 0.61, 95% CI 0.59–0.63; accuracy = 0.58, 95% CI 0.57–0.59). Conclusions: DBT-based radiomic analysis seems to have only limited potential in discriminating benign from malignant microcalcifications

Cell-free biomimetic polyurethane-based scaffold for breast reconstruction following non-malignant lesion resection. A first-in-human study

Abstract Background Based on the volume of tissue removed, conservative surgery (BCS) cannot always guarantee satisfactory cosmetic results, unless resorting to more complex oncoplastic approaches. Investigating an alternative to optimize aesthetic outcomes minimizing surgical complexity, was the purpose of this study. We assessed an innovative surgical procedure based on the use of a biomimetic polyurethane-based scaffold intended for regenerating soft-tissue resembling fat, in patients undergoing BCS for non-malignant breast lesions. Safety and performance of the scaffold, and safety and feasibility of the entire implant procedure were evaluated. Methods A volunteer sample of 15 female patients underwent lumpectomy with immediate device positioning, performing seven study visits with six-month follow-up. We evaluated incidence of adverse events (AEs), changes in breast appearance (using photographs and anthropomorphic measurements), interference with ultrasound and MRI (assessed by two independent investigators), investigator’s satisfaction (through a VAS scale), patient’s pain (through a VAS scale) and quality of life (QoL) (using the BREAST-Q© questionnaire). Data reported are the results of the interim analysis on the first 5 patients. Results No AEs were device related nor serious. Breast appearance was unaltered and the device did not interference with imaging. High investigator’s satisfaction, minimal post-operative pain and positive impact on QoL were also detected. Conclusions Albeit on a limited number of patients, data showed positive outcomes both in terms of safety and performance, paving the way to an innovative breast reconstructive approach with a potential remarkable impact on clinical application of tissue engineering. Trial registration ClinicalTrials.gov (NCT04131972, October 18, 2019)