Journal highlights

Obesity, measured by body mass index (BMI), is considered a risk factor for cardiovascular disease and cancer. However, the “obesity paradox” suggests that higher BMI may improve survival in certain cancers, especially following lung cancer surgery.

BMI cannot differentiate muscle from fat mass or account for fat distribution—key factors in cancer prognosis. Recent research recognizes the importance of skeletal muscle health; declining muscle mass and radiodensity are linked to poorer outcomes in various cancers. But few studies have examined skeletal muscle health and obesity in the context of cancer survival.

A recent Radiology study led by Ji Hyun Lee, MD, PhD, and Danbee Kang, PhD, from Sungkyunkwan University in Seoul, Korea, investigated the association between BMI-defined obesity and survival in 7,076 patients with non–small cell lung cancer. Findings showed that obesity, combined with preserved skeletal muscle mass, was associated with better overall survival, especially in men and patients with a history of smoking.

“Although BMI is a useful and practical tool for initial assessment, it should be complemented by detailed body composition measurements to better understand the obesity paradox in non–small cell lung cancer,” the authors summarized.

Read the full article, “Association of Obesity and Skeletal Muscle with Postoperative Survival in Non–Small Cell Lung Cancer.”

Follow the Radiology editor on X @RadiologyEditor.

Patients with a prior history of breast cancer (PHBC) have longer life expectancies because of early detection and improved treatments. But they remain at increased risk for recurrent or subsequent breast cancer, and effective imaging surveillance is critical.

National and international organizations recommend annual mammography, but screening indications and protocols are not standardized. Furthermore, the sensitivity of mammography is decreased in patients with PHBC compared with nonaffected patients. Supplemental modalities come with their own benefits and limitations.

A recent RadioGraphics article by Sona A. Chikarmane, MD, and Catherine S. Giess, MD, from Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston, provides an in-depth review of current guidelines for patients with PHBC. The authors discuss the challenges and controversies involved and describe emerging modalities including whole-breast US and digital breast tomosynthesis.

“Further work, including that involving risk-based assessments and the use of artificial intelligence, is needed to stratify patients’ risk,” the authors conclude.

Read the full article, “Breast Cancer Surveillance in Patients with a Prior Personal History of Breast Cancer: Updates and Controversies.” This article is also available for CME on EdCentral. Follow the RadioGraphics editor on X @RadG_Editor.

Patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (OPSCC) typically experience high disease control and survival rates with either upfront surgery or radiation therapy.

As such, upfront surgical management is usually not favored when pathologic extranodal extension (pENE) and/or positive margins are expected, unless other patient- or treatment-related concerns favor surgery. Reliable identification of pENE during initial patient workup is essential.

In a recent study published in Radiology: Imaging Cancer, Ryan T. Hughes, MD, Wake Forest University School of Medicine in Winston-Salem, NC, and colleagues looked at preoperative contrast-enhanced CT (CECT) studies in 162 patients who underwent surgical resection. The team identified multiple CECT-based imaging features associated with pENE and developed a decision tree model (DTM) to predict its probability. The DTM accurately diagnosed pENE with 97% specificity.

“We developed a pragmatic DTM to predict the probability of pENE in patients with OPSCC, based on CECT features from pretreatment imaging. This simple model that could be quickly administered in routine clinical practice and multidisciplinary tumor boards warrants further validation,” the authors conclude.

Read the full article, “Predicting Extranodal Extension with Preoperative Contrast-enhanced CT in Patients with Oropharyngeal Squamous Cell Carcinoma.”

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