Rapid Differential Diagnosis of Breast Microcalcification Using Targeted Near-Infrared Fluorophores

A Mammography-Based Radiomic Nomogram for Predicting Malignancy in Breast Suspicious Microcalcifications

RATIONALE AND OBJECTIVES

Preoperative accurate identification of benign and malignant breast lesions is vital for patients to achieve individualized treatment. This study aimed to develop and validate a mammography-based radiomic nomogram for predicting malignant risk of breast suspicious microcalcifications (MCs).

MATERIALS AND METHODS

496 patients with histologically confirmed breast suspicious MCs were randomly divided into the training set (n = 346) and validation set (n = 150). Radiomics features was extracted from the craniocaudal and mediolateral oblique images. Least absolute shrinkage and selection operator algorithm were used to select radiomics features, then radiomics score (Rad-score) was calculated. Univariate analysis was used to identify malignant MCs-related clinical independent risk factors. Multivariate logistic regression was used to establish a clinical-radiomics model by incorporating Rad-score and clinic factors. A nomogram was developed to visualize the clinical-radiomics model. The receiver operating characteristic curve, calibration curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram.

RESULTS

The Rad-score was consisted of 29 optimal radiomics features. We developed a nomogram by incorporating Rad-score, menopause status, MCs morphology and distribution, the area under the curve value of the combined model was 0.926(95% confidence interval [CI]: 0.878-0.975) for the validation set. The calibration curves and DCA indicated the combined model had favorable calibration and clinical utility.

CONCLUSION

The combined model could be considered as a potential imaging marker to predict malignant risk of breast suspicious MCs.

Diagnostic performance of DCE-MRI, multiparametric MRI and multimodality imaging for discrimination of breast non-mass-like enhancement lesions

OBJECTIVE

The aim of this study was to investigate and compare the diagnostic performance of dynamic contrast-enhanced (DCE)-MRI, multiparametric MRI (mpMRI), and multimodality imaging (MMI) combining mpMRI and mammography (MG) for discriminating breast non-mass-like enhancement (NME) lesions.

METHODS

This retrospective study enrolled 193 patients with 199 lesions who underwent 3.0 T MRI and MG from January 2017 to December 2019. The features of DCE-MRI, turbo inversion recovery magnitude (TIRM), and diffusion-weighted imaging (DWI) were assessed by two breast radiologists. Then, all lesions were divided into microcalcification and non-microcalcification groups to assess the features of MG. Comparisons were performed between groups using univariate analyses. Then, multivariate analyses were performed to construct diagnostic models for distinguishing NME lesions. Diagnostic performance was evaluated by using the area under the curve (AUC) and the differences between AUCs were evaluated by using the DeLong test.

RESULTS

Overall (n = 199), mpMRI outperformed DCE-MRI alone (AUCmpMRI = 0.924 vs. AUCDCE-MRI = 0.884; p = 0.007). Furthermore, MMI outperformed both mpMRI and MG (the microcalcification group [n = 140]: AUCMMI = 0.997 vs. AUCmpMRI = 0.978, p = 0.018 and AUCMMI = 0.997 vs. AUCMG = 0.912, p < 0.001; the non-microcalcification group [n = 59]: AUCMMI = 0.857 vs. AUCmpMRI = 0.768, p = 0.044 and AUCMMI = 0.857 vs. AUCMG = 0.759, p = 0.039).

CONCLUSION & ADVANCES IN KNOWLEDGE

DCE-MRI combined with DWI and TIRM information could improve the diagnostic performance for discriminating NME lesions compared with DCE-MRI alone. Furthermore, MMI combining mpMRI and MG showed better discrimination than both mpMRI and MG.

Tumor-targeted near-infrared fluorophore for fluorescence-guided phototherapy

A tumor-targeted near-infrared (NIR) fluorophore CA800SO3 was developed for fluorescence-guided phototherapy. This new type of NIR fluorophore showed high tumor targetability based on the structure-inherent targeting approach. This fluorophore generated sufficient hyperthermia and reactive oxygen species (ROS) simultaneously for synergistic cancer phototherapy, induced by an 808 nm laser irradiation.

Zwitterionic near-infrared fluorophore for targeted photothermal cancer therapy

A zwitterionic NIR fluorophore ZW800-Cl showed intrinsic preferential tumor accumulation and an excellent photothermal capability without the need for chemical modifications with tumor-specific ligands and photosensitizers.

Mammography-based radiomic analysis for predicting benign BI-RADS category 4 calcifications

PURPOSE

We developed and validated a radiomic model based on mammography and assessed its value for predicting the pathological diagnosis of Breast Imaging Reporting and Data System (BI-RADS) category 4 calcifications.

MATERIALS AND METHODS

Patients with a total of 212 eligible calcifications were recruited (159 cases in the primary cohort and 53 cases in the validation cohort). In total, 8286 radiomic features were extracted from the craniocaudal (CC) and mediolateral oblique (MLO) images. Machine learning was used to select features and build a radiomic signature. The clinical risk factors were selected from the independent clinical factors through logistic regression analyses. The radiomic nomogram incorporated the radiomic signature and an independent clinical risk factor. The diagnostic performance of the radiomic model and the radiologists' empirical prediction model was evaluated by the area under the receiver operating characteristic curve (AUC). The differences between the various AUCs were compared with DeLong's test.

RESULTS

Six radiomic features and the menopausal state were included in the radiomic nomogram, which discriminated benign calcifications from malignant calcifications with an AUC of 0.80 in the validation cohort. The difference between the classification results of the radiomic nomogram and that of radiologists was significant (p < 0.05). Particularly for patients with calcifications that are negative on ultrasounds but can be detected by mammography (MG+/US- calcifications), the identification ability of the radiomic nomogram was very strong.

CONCLUSIONS

The mammography-based radiomic nomogram is a potential tool to distinguish benign calcifications from malignant calcifications.

Near-Infrared Fluorescent Sorbitol Probe for Targeted Photothermal Cancer Therapy

Abstract: Photothermal therapy (PTT) using a near-infrared (NIR) heptamethine cyanine fluorophore has emerged as an alternative strategy for targeted cancer therapy. NIR fluorophores showing a high molar extinction coefficient and low fluorescence quantum yield have considerable potential applications in photothermal cancer therapy. In this study, a bifunctional sorbitol-ZW800 conjugate was used as an advanced concept of photothermal therapeutic agents for in vivo cancer imaging and therapy owing to the high tumor targetability of the sorbitol moiety and excellent photothermal property of NIR heptamethine cyanine fluorophore. The sorbitol-ZW800 showed an excellent photothermal effect increased by 58.7 °C after NIR laser irradiation (1.1 W/cm2) for 5 min. The HT-29 tumors targeted by sorbitol-ZW800 showed a significant decrease in tumor volumes for 7 days after photothermal treatment. Therefore, combining the bifunctional sorbitol-ZW800 conjugate and NIR laser irradiation is an alternative way for targeted cancer therapy, and this approach holds great promise as a safe and highly efficient NIR photothermal agent for future clinical applications.

Near-Infrared Contrast Agents for Bone-Targeted Imaging

Background

For the bone-specific imaging, a structure-inherent targeting of bone tissue recently has been reported a new strategy based on incorporation of targeting moieties into the chemical structure of near-infrared (NIR) contrast agents, while conventional methods require covalent conjugation of bone-targeting ligands to NIR contrast agents. This will be a new approach for bone-targeted imaging by using the bifunctional NIR contrast agents.

Methods

The goal of this review is to provide an overview of the recent advances in optical imaging of bone tissue, highlighting the structure-inherent targeting by developing NIR contrast agents without the need for a bone-targeting ligand such as bisphosphonates.

Results

A series of iminodiacetated and phosphonated NIR contrast agents for the structure-inherent targeting of bone tissue showed excellent bone-targeting ability in vivo without non-specific binding. Additionally, the phosphonated NIR contrast agents could be useful in the diagnosis of bone metastasis.

Conclusion

By developing bone-targeted NIR contrast agents, optical imaging of bone tissue makes it very attractive for preclinical studies of bone growth or real-time fluorescence guided surgery resulting in high potential to shift the clinical paradigms.