Contrast enhanced spectral mammography (CESM) guided breast biopsy as an alternative to MRI guided biopsy

Objective: Contrast Enhanced Spectral Mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI guided biopsy. Methods and materials: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally this would have necessitated a MRI guided breast biopsy, but was performed under CESM guidance. Results: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. Conclusion: CESM guided breast biopsy is a new technique that can be successfully used as an alternative to MRI guided breast biopsy. Advances in knowledge: CESM guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.

Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis

Background Oncoplastic surgery is a well-established approach that combines breast-conserving treatment for breast cancer and plastic surgery techniques. Although this approach already has been described for multicentric and multifocal tumors, no long-term oncologic follow-up evaluation and no comparison with patients undergoing mastectomy have been published. This study aimed to evaluate whether oncoplastic surgery is a safe and reliable treatment for managing invasive primary multicentric and multifocal breast cancer. Methods The study compared a consecutive series of 100 patients with multicentric or multifocal tumors who had undergone oncoplastic surgery (study group) with 100 patients who had multicentric or multifocal tumors and had undergone mastectomy (control group) during a prolonged period. The end points evaluated were disease-free survival (DFS), overall survival (OS), cumulative incidence of local recurrence (CI-L), regional recurrence (CI-R), and distant recurrence (CI-D), all measured from the date of surgery. Results The OS and DFS were similar between the two groups. The incidence of local events was higher in the oncoplastic group, whereas the incidence of regional events was slightly higher in the mastectomy group. These differences were not statistically significant. The cumulative incidence of distant events was similar between the two groups. Conclusions To the authors’ knowledge, the current study provides the best available evidence suggesting that the oncoplastic approach is a safe and reliable treatment for managing invasive multifocal and multicentric breast cancers.

Integrative Clonal Evolution Analysis on SNV and CNV Levels in Multifocal Breast Cancer

Background:For multifocal or multicentric breast cancer with two or more separated malignant foci in ipsilateral breast, the origin of its multiple foci is still debatable: do they share a common origin or have they developed independently?Methods:By bulk exome sequencing combined with single cell whole genome sequencing using multiple annealing and looping-based amplification cycles (MALBAC), we obtained genomic information of two separated breast tumors and one metastatic lymph node in a multifocal breast cancer patient. We performed single nucleotide variation (SNV) and single cell copy number variation (CNV) analyses of the two breast tumors and lymph node. Results:On SNV level, we found common origin and single focus metastasis in this patient, concretely speaking that the two breast tumors were formed by the spread of one single tumor to another, instead of being developed independently. Furthermore, the lymph node was metastasized from one of the two tumors instead of co-metastasis by both of them. We also found that the SNV subclone architecture always kept stable between the two breast tumors as well as from the breast tumors to lymph node. On CNV level, in contrast, the frequency of CNV subclones changed dramatically from the breast tumors to lymph node. Among them, frequency of Clone 2 increased significantly, indicating metastatic advantages of it. By combining distinct clonal evolution patterns of SNVs and CNVs, we built an integrative evolutionary model for this patient. CNV subclones were determined at a relative early time and kept unchanged, and CNV Clone 2 with metastatic advantages was separated from the common ancestors during intramammary spread and metastasis. In the meantime, SNVs were accumulated gradually. Conclusions: In conclusion, we found distinct clonal evolution patterns on SNV and CNV levels in multifocal breast cancer and identified a CNV clone with metastatic advantages.

Integrative Clonal Evolution Analysis on SNV and CNV Levels in Multifocal Breast Cancer

Background: For multifocal or multicentric breast cancer with two or more separated malignant foci in ipsilateral breast, the origin of its multiple foci is still debatable: do they share a common origin or have they developed independently? Methods: By bulk exome sequencing combined with single cell whole genome sequencing using multiple annealing and looping-based amplification cycles (MALBAC), we obtained genomic information of two separated breast tumors and one metastatic lymph node in a multifocal breast cancer patient. We performed single nucleotide variation (SNV) and single cell copy number variation (CNV) analyses of the two breast tumors and lymph node. Results: On SNV level, we found common origin and single focus metastasis in this patient, concretely speaking that the two breast tumors were formed by the spread of one single tumor to another, instead of being developed independently. Furthermore, the lymph node was metastasized from one of the two tumors instead of co-metastasis by both of them. We also found that the SNV subclone architecture always kept stable between the two breast tumors as well as from the breast tumors to lymph node. On CNV level, in contrast, the frequency of CNV subclones changed dramatically from the breast tumors to lymph node. Among them, frequency of Clone 2 increased significantly, indicating metastatic advantages of it. By combining distinct clonal evolution patterns of SNVs and CNVs, we built an integrative evolutionary model for this patient. CNV subclones were determined at a relative early time and kept unchanged, and CNV Clone 2 with metastatic advantages was separated from the common ancestors during intramammary spread and metastasis. In the meantime, SNVs were accumulated gradually. Conclusions: In conclusion, we found distinct clonal evolution patterns on SNV and CNV levels in multifocal breast cancer and identified a CNV clone with metastatic advantages.

Phase Compensation Technique for Effective Heat Focusing in Microwave Hyperthermia Systems

In this paper, effective electromagnetic (EM) focusing achieved with a phase compensation technique for microwave hyperthermia systems is proposed. To treat tumor cells positioned deep inside a human female breast, EM energy must be properly focused on the target area. A circular antenna array for microwave hyperthermia allows EM energy to concentrate on a specific target inside the breast tumor. Depending on the cancerous cell conditions in the breast, the input phases of each antenna are calculated for single and multiple tumor cell locations. In the case of multifocal breast cancer, sub-array beam focusing via the phase compensation technique is presented to enhance the ability of EM energy to concentrate on multiple targets while minimizing damage to normal cells. To demonstrate the thermal treatment effects on single and multiple tumor locations, the accumulation of the specific absorption rate (SAR) parameter and temperature changes were verified using both simulated and experimental results.