Accuracy of Breast Magnetic Resonance Imaging (MRI) and Breast Ultrasound Compared to Pathology in Assessing Residual Tumor in Breast Cancer Patients Receiving Neoadjuvant Systemic Treatment at Siriraj Hospital

Objective: To evaluate the accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in assessing residual tumor size compared to pathological findings in breast cancer patients who received neoadjuvant systemic treatment (NAST), and to examine the influence of imaging on surgical planning across different molecular subtypes. Materials and Methods: This retrospective study included 24 breast cancer patients who underwent NAST followed by surgery at Siriraj Hospital between 2016 and 2024. Preoperative breast MRI and breast US, performed within 3–6 weeks prior to surgery, were compared with pathological tumor size. Analysis focused on mass lesions, with nonmass enhancement (NME) considered in selected cases where it presented. Imaging findings were independently reviewed by a second, blinded radiologist. Concordance between imaging and pathology was assessed. Results: A total 24 patients were analyzed. MRI showed superior agreement with pathological tumor size, with 91.7% of cases falling within a ±10 mm margin, compared to 70.0% for US. Mean tumor sizes were 5.4 mm for MRI, 8.3 mm for US, and 10.9 mm based on pathological examination. Bland-Altman analysis revealed better agreement between MRI and pathology (limits of agreement: –23.5 – 34.5 mm) compared to US. These results highlight the superior accuracy and reliability of MRI over US for preoperative tumor size assessment. Conclusion: MRI demonstrates greater accuracy than US in evaluating residual disease following NAST. In case of invasive lobular carcinoma (ILC) subtypes, incorporating NME into imaging assessment may improve concordance with pathological findings. MRI should be considered a standard modality in preoperative evaluation to optimize surgical planning

Ex vivo recovery and activation of dysfunctional, anergic, monocyte-derived dendritic cells from patients with operable breast cancer: critical role of IFN-alpha

Background Dendritic cells (DCs) play a crucial role in initiating effective cell-mediated immune responses, but are dysfunctional and anergic in breast cancer. Reversal of this dysfunction and establishment of optimal DC function is a key prerequisite for the induction of effective anti-cancer immune responses. Results Peripheral blood DCs (PBDCs) and lymph node DCs (LNDCs) generated in vitro from adherent cultures of peripheral blood monocytes (PBMs) and lymph node monocytes (LNMs), respectively, using the 4 cytokine conditioned medium (CCM) (GM-CSF+IL-4+TNF-α+IFN-α) or 3 CCM (GM-CSF+IL-4+TNF-α) demonstrated a significantly higher degree of recovery and functional capacity in a mixed lymphocyte DC reaction (MLDCR, p < 0.001), expressed significantly higher levels of HLA-DR, CD86, compared with 2 CCM (GM-CSF+IL-4) or medium alone generated DCs from PBMs and LNMs (p < 0.001). The PBDCs generated with 3 CCM or 4 CCM showed a significantly (p < 0.001) enhanced macropinocytotic capability (dextran particles) and induced increased production and secretion of interleukin-12p40 (IL-12p40) in vitro (p < 0.001), compared with PBDCs generated from monocytes using 2 CCM or medium alone. Lipopolysaccharide (LPS) stimulation of PBDCs generated with 4 CCM demonstrated enhanced secretion of IL-6 but not IL-12p70, compared with control DCs unstimulated with LPS (p < 0.001). Conclusion Dysfunctional and anergic PBDCs and LNDCs from patients with operable breast cancer can be optimally reversed by ex vivo culturing of precursor adherent monocytes using a 4 CCM containing IFN-α. Maximal immunophenotypic recovery and functional reactivation of DCs is seen in the presence of IFN-α. However, 4 CCM containing IFN-α generated-PBDCs, do not produce and secrete IL-12p70 in vitro

Metaplastic carcinoma of the breast with transformation from adenosquamous carcinoma to osteosarcomatoid and spindle cell morphology

Metaplastic carcinoma of the breast refers to a heterogenous group of mammary carcinomas that contain a mixture of various cell types, including squamous cells, spindle cells and/or a mesenchymal component, such as bone or cartilage. To the best of our knowledge, the clinical course of a tumour that has undergone a transformation from one type of metaplastic carcinoma to another subtype has not previously been reported. The present study reports the five-year clinical and pathological course of a metaplastic breast carcinoma in a 55-year-old female, who was diagnosed with a sclerosing fibroadenomatous nodule with osseous metaplasia and focal atypia. A recurrent tumour was documented four years later, showing a predominant component of osteosarcoma with adenosquamous carcinoma. Upon pathological review of the initial mass, the diagnosis was changed to low-grade adenosquamous carcinoma. The patient was treated with breast conserving therapy. However, one year later, a recurrent metaplastic carcinoma with spindle cell morphology was documented and surgically removed by mastectomy. Subsequently, pulmonary invasion of the chest wall occurred and the patient eventually succumbed due to the invasive nature of the disease

Improving breast cancer detection using ultrasonography in asymptomatic women with non-fatty breast density

Background Mammography (MX) is a reliable modality for detection of breast cancer in asymptomatic women. Use of additional whole breast ultrasonography (US) for breast cancer screening is widely recognized, in particular in women with dense breast parenchyma. Purpose To determine the subgroup of women, according to breast density and age, who receive most benefit from US following MX for detection of breast cancer in an asymptomatic condition. Material and Methods The study was conducted in asymptomatic women who had non-fatty breast parenchyma using MX and US during January 2006 and December 2007. Mammographic breast density was classified as recommended by ACR BI-RADS lexicon. Non-fatty breast referred to D2, D3, and D4. US was performed by the same radiologists who interpreted MX with a handheld machine during the same visit. Data on demographics, cancer detection rate (CDR), and incremental cancer detection rate (ICDR) were analyzed using 95% confident interval (CI). Results Of 14,483 breast cancer screenings in women who had non-fatty breast density, 115 cancers were documented. The mean age of cancer patients was 49.6 years. Of 115 cancers, 105 were evidenced on images (31 with MX alone, 19 with US alone, and 55 with both MX and US). Overall CDR was 7.9 per 1000 examination (95% CI, 6.5–9.5). CDR for MX only (MX-CDR) was 6.5 per 1000 examinations (95% CI, 5.2–7.9). Additional US could significantly improve CDR ( P &lt; 0.001; 95% CI, 0.9–2.2); US-ICDR was 1.4 per 1000 examinations. According to age group, the group of 40–59 years had statistically significant improvement of ICDR ( P &lt; 0.001). The ICDR was highest in D4 breast density (D4) (US-ICDR = 2.5 per 1000 examinations). Conclusion Use of US adjunct to MX for detection of breast cancer in asymptomatic non-fatty, average-risk women for detection of breast cancer is a promising diagnostic procedure. A significant benefit was documented, in particular, in women aged 40–59 years old, and in women with D4 breast density. </jats:sec