Associations of mammographic dense and nondense areas and body mass index with risk of breast cancer

Mammographic density measurements are associated with risk of breast cancer. Few studies have investigated the concurrent associations of mammographic dense and nondense areas, body mass index (weight (kg)/height (m)(2)), and ages at mammogram and diagnosis with breast cancer risk. We conducted a matched, case-control study nested within the Melbourne Collaborative Cohort Study (cohort recruitment in 1990-1994 and follow-up until 2007) to estimate the associations between these factors and breast cancer risk under alternative causal models. Mammographic dense area was positively associated with risk, and the strength of this association was only slightly influenced by the choice of the causal model (relative risk per 1 standard deviation = 1.50, 95% confidence interval: 1.32, 1.70). Mammographic nondense area was inversely associated with risk under the assumption that fat in the body and fat in the breast cause breast cancer through independent mechanisms (relative risk per 1 standard deviation = 0.75, 95% confidence interval: 0.65, 0.86), whereas it was not associated with risk under the assumption that they are both proxies of adiposity. Knowledge about the biological mechanisms regulating the role played by mammographic nondense area and body fat on breast cancer risk is essential to better estimate their impacts on individual risk.

Anthropomorphic breast phantoms with physiological water, lipid, and hemoglobin content for near-infrared spectral tomography

Breast mimicking tissue optical phantoms with sufficient structural integrity to be deployed as stand-alone imaging targets are developed and successfully constructed with biologically relevant concentrations of water, lipid, and blood. The results show excellent material homogeneity and reproducibility with inter- and intraphantom variability of 3.5 and 3.8%, respectively, for water and lipid concentrations ranging from 15 to 85%. The phantoms were long-lasting and exhibited water and lipid fractions that were consistent to within 5% of their original content when measured 2 weeks after creation. A breast-shaped three-compartment model of adipose, fibroglandular, and malignant tissues was created with water content ranging from 30% for the adipose simulant to 80% for the tumor. Mean measured water content ranged from 30% in simulated adipose to 73% in simulated tumor with the higher water localized to the tumor-like material. This novel heterogeneous phantom design is composed of physiologically relevant concentrations of the major optical absorbers in the breast in the near-infrared wavelengths that should significantly improve imaging system characterization and optimization because the materials have stand-alone structural integrity and can be readily molded into the sizes and shapes of tissues commensurate with clinical breast imaging.

Harmonic motion microwave Doppler imaging: a simulation study using a simple breast model

A hybrid method for tissue imaging using dielectric and elastic properties is proposed and investigated with simple bi-layered breast model. In this method, local harmonic motion is generated in the tissue using a focused ultrasound probe. A narrow-band microwave signal is transmitted to the tissue. The Doppler component of the scattered signal, which depends on the dielectric and elastic properties of the vibrating region, is sensed. A plane-wave spectrum technique is used together with reciprocity theorem for calculating the response of a vibrating electrically small spherical tumor in breast tissue. The effects of operating frequency, antenna alignment and distance, and tumor depth on the received signal are presented. The effect of harmonic motion frequency on the vibration amplitude and displacement distribution is investigated with mechanical simulations using the finite element method. The safety of the method is analyzed in terms of microwave and ultrasound exposure of the breast tissue. The results show that the method has a potential in detecting tumors inside fibro-glandular breast tissue.

Non-uniformly under-sampled multi-dimensional spectroscopic imaging in vivo: maximum entropy versus compressed sensing reconstruction

The four-dimensional (4D) echo-planar correlated spectroscopic imaging (EP-COSI) sequence allows for the simultaneous acquisition of two spatial (ky, kx) and two spectral (t2, t1) dimensions in vivo in a single recording. However, its scan time is directly proportional to the number of increments in the ky and t1 dimensions, and a single scan can take 20–40 min using typical parameters, which is too long to be used for a routine clinical protocol. The present work describes efforts to accelerate EP-COSI data acquisition by application of non-uniform under-sampling (NUS) to the ky–t1 plane of simulated and in vivo EP-COSI datasets then reconstructing missing samples using maximum entropy (MaxEnt) and compressed sensing (CS). Both reconstruction problems were solved using the Cambridge algorithm, which offers many workflow improvements over other l1-norm solvers. Reconstructions of retrospectively under-sampled simulated data demonstrate that the MaxEnt and CS reconstructions successfully restore data fidelity at signal-to-noise ratios (SNRs) from 4 to 20 and 5× to 1.25× NUS. Retrospectively and prospectively 4× under-sampled 4D EP-COSI in vivo datasets show that both reconstruction methods successfully remove NUS artifacts; however, MaxEnt provides reconstructions equal to or better than CS. Our results show that NUS combined with iterative reconstruction can reduce 4D EP-COSI scan times by 75% to a clinically viable 5 min in vivo, with MaxEnt being the preferred method.

Volumetric breast density estimation from full-field digital mammograms: a validation study

OBJECTIVES

To objectively evaluate automatic volumetric breast density assessment in Full-Field Digital Mammograms (FFDM) using measurements obtained from breast Magnetic Resonance Imaging (MRI).

MATERIAL AND METHODS

A commercially available method for volumetric breast density estimation on FFDM is evaluated by comparing volume estimates obtained from 186 FFDM exams including mediolateral oblique (MLO) and cranial-caudal (CC) views to objective reference standard measurements obtained from MRI.

RESULTS

Volumetric measurements obtained from FFDM show high correlation with MRI data. Pearson's correlation coefficients of 0.93, 0.97 and 0.85 were obtained for volumetric breast density, breast volume and fibroglandular tissue volume, respectively.

CONCLUSIONS

Accurate volumetric breast density assessment is feasible in Full-Field Digital Mammograms and has potential to be used in objective breast cancer risk models and personalized screening.

Hybrid photomultiplier tube and photodiode parallel detection array for wideband optical spectroscopy of the breast guided by magnetic resonance imaging

A new optical parallel detection system of hybrid frequency and continuous-wave domains was developed to improve the data quality and accuracy in recovery of all breast optical properties. This new system was deployed in a previously existing system for magnetic resonance imaging (MRI)-guided spectroscopy, and allows incorporation of additional near-infrared wavelengths beyond 850 nm, with interlaced channels of photomultiplier tubes (PMTs) and silicon photodiodes (PDs). The acquisition time for obtaining frequency-domain data at six wavelengths (660, 735, 785, 808, 826, and 849 nm) and continuous-wave data at three wavelengths (903, 912, and 948 nm) is 12 min. The dynamic ranges of the detected signal are 105 and 106 for PMT and PD detectors, respectively. Compared to the previous detection system, the SNR ratio of frequency-domain detection was improved by nearly 103 through the addition of an RF amplifier and the utilization of programmable gain. The current system is being utilized in a clinical trial imaging suspected breast cancer tumors as detected by contrast MRI scans.

Comparing average breast fat content results from two different protocols at 1.5T and 3T: can the data be pooled?

PURPOSE

To compare the total breast fat content computed from two separate studies, performed on different scanners and with different protocols, with the goal of defining a relationship to allow pooling the data.

MATERIALS AND METHODS

Twelve healthy volunteer women were scanned with two different protocols on the same day. The protocols differed in four important aspects: vendors (GE vs. Philips), scanner main magnetic field strengths (1.5T vs. 3T), pulse sequences (2D fast spin-echo vs. 3D spoiled gradient-echo), and water/fat separation techniques. The resulting water and fat maps were processed with in-house software to extract breast tissue slice-wise. Percent fat content was calculated for each breast, per subject.

RESULTS

Total percent fat contents (averaged across both breasts) resulting from both protocols were plotted against each other, on a subject-by-subject basis, revealing a strong correlation (R(2)  > 0.99), with an overestimation of the fat content from Protocol 1 relative to Protocol 2. The proposed T2 TE-correction for Protocol 1 improves the correlation while decreasing the discrepancy between protocols.

CONCLUSION

Total breast fat content of healthy women resulting from the two protocols can be pooled using a linear relationship. The proposed T2 TE-corrected Protocol 1 is expected to yield accurate fat content.

Men's oppressive beliefs predict their breast size preferences in women

Previous studies of men's breast size preferences have yielded equivocal findings, with studies variously indicating a preference for small, medium, or large breasts. Here, we examined the impact of men's oppressive beliefs in shaping their female breast size ideals. British White men from the community in London, England (N = 361) viewed figures of women that rotated in 360° and varied in breast size along five levels. They then rated the figure that they found most physically attractive and also completed measures assessing their sexist attitudes and tendency to objectify women. Results showed that medium breasts were rated most frequent as attractive (32.7 %), followed by large (24.4 %) and very large (19.1 %) breasts. Further analyses showed that men's preferences for larger female breasts were significantly associated with a greater tendency to be benevolently sexist, to objectify women, and to be hostile towards women. These results were discussed in relation to feminist theories, which postulate that beauty ideals and practices in contemporary societies serve to maintain the domination of one sex over the other.

Adiabatic multi-echo ³¹P spectroscopic imaging (AMESING) at 7 T for the measurement of transverse relaxation times and regaining of sensitivity in tissues with short T₂ values

An adiabatic multi-echo spectroscopic imaging (AMESING) sequence, used for (31) P MRSI, with spherical k-space sampling and compensated phase-encoding gradients, was implemented on a whole-body 7-T MR system. One free induction decay (FID) and up to five symmetric echoes can be acquired with this sequence. In tissues with low T2 and high T2 , this can theoretically lead to a potential maximum signal-to-noise ratio (SNR) increase of almost a factor of three, compared with a conventional FID acquisition with Ernst-angle excitation. However, with T2 values being, in practice, ≤400 ms, a maximum enhancement of approximately two compared with low flip Ernst-angle excitation should be feasible. The multi-echo sequence enables the determination of localized T2 values, and was validated with (31) P three-dimensional MRSI on the calf muscle and breast of a healthy volunteer, and subsequently applied in a patient with breast cancer. The T2 values of phosphocreatine, phosphodiesters (PDE) and inorganic phosphate in calf muscle were 193 ± 5 ms, 375 ± 44 ms and 96 ± 10 ms, respectively, and the apparent T2 value of γ-ATP was 25 ± 6 ms. A T2 value of 136 ± 15 ms for inorganic phosphate was measured in glandular breast tissue of a healthy volunteer. The T2 values of phosphomonoesters (PME) and PDE in breast cancer tissue (ductulolobular carcinoma) ranged between 170 and 210 ms, and the PME to PDE ratios were calculated to be phosphoethanolamine/glycerophosphoethanolamine = 2.7, phosphocholine/glycerophosphocholine = 1.8 and PME/PDE = 2.3. Considering the relatively short T2 values of the metabolites in breast tissue at 7 T, the echo spacing can be short without compromising spectral resolution, whilst maximizing the sensitivity.

Amide proton transfer imaging of the human breast at 7T: development and reproducibility

Chemical exchange saturation transfer (CEST) can offer information about protons associated with mobile proteins through the amide proton transfer (APT) effect, which has been shown to discriminate tumor from healthy tissue and, more recently, has been suggested as a prognosticator of response to therapy. Despite this promise, APT effects are small (only a few percent of the total signal), and APT imaging is often prone to artifacts resulting from system instability. Here we present a procedure that enables the detection of APT effects in the human breast at 7T while mitigating these issues. Adequate signal-to-noise ratio (SNR) was achieved via an optimized quadrature RF breast coil and 3D acquisitions. To reduce the influence of fat, effective fat suppression schemes were developed that did not degrade SNR. To reduce the levels of ghosting artifacts, dummy scans have been integrated into the scanning protocol. Compared with results obtained at 3T, the standard deviation of the measured APT effect was reduced by a factor of four at 7T, allowing for the detection of APT effects with a standard deviation of 1% in the human breast at 7T. Together, these results demonstrate that the APT effect can be reliably detected in the healthy human breast with a high level of precision at 7T.

[Digital evaluation of breast symmetry with 3D scanning technique]

OBJECTIVE

To establish a standard method for digital evaluation of breast symmetry with 3D scanning technique.

METHODS

From January 2009 to July 2010, 167 patients received 3D scanning before breast augmentation. The coordinate system was established and the 3D reconstructed breast models were analyzed by software. The discrepancy of nipple level, the distance between nipple to midline, inferior mammary fold location, breast width, breast projection, breast volume and anterior chest wall projection were measured.

RESULTS

The mean discrepancy of nipple level, the distance between nipple to midline, IMF level, breast width, breast projection and anterior chest wall projection were (4. 8 +/- 3.9) mm, (4.5 +/- 3.4) mm, (4.6 +/- 3.7) mm, (4.8 +/- 2.9) mm, (5.4 +/- 3.9) mm and (4.8 +/- 3.3) mm, respectively. The mean difference of breast volume was (51 +/- 44) ml. The incidence of significant asymmetry was 73% (122/167)in nipple position, 95% (159/167)in breast shape, 38% (63/167)in anterior chest wall projection.

CONCLUSIONS

3D scanning technique can provide an accurate 3D measurement of breast. A thorough and objective evaluation of breast symmetry can be achieved.

Adolescent and young adult exposure to physical activity and breast density

PURPOSE

The objective of this study is to examine the role of early lifetime exposure to physical activity on magnetic resonance imaging-determined breast density measures.

METHODS

Associations of adolescent (high school (ages 14-17 yr) and early adulthood, post-high school (ages 18-21 yr) and past year) leisure-time physical activity, as well as a principal component score including all three estimates, were examined with percent dense breast volume (%DBV) and absolute dense breast volume (ADBV) in a cross-sectional analysis of 182 healthy women, ages 25-29 yr, enrolled in the Dietary Intervention Study in Children Follow-up Study (DISC06). Generalized linear mixed models were used to examine associations after adjustment for relevant covariates for the entire analytic sample. Analyses were repeated in nulliparous women and hormonal contraceptive nonusers.

RESULTS

Physical activity during high school and post-high school were not statistically significantly related to %DBV or ADBV in multivariable models. Past year physical activity was positively related to %DBV in the unadjusted and partially adjusted models (P < 0.001 and P = 0.01, respectively), which did not adjust for body mass index (BMI). After additional adjustment for childhood and early adulthood BMI, this association became nonstatistically significant. The relation between past year physical activity and ADBV was not statistically significant. These findings were similar in nonusers of hormonal contraceptives. No statistically significant relations were found in nulliparous women or between the principal component score and %DBV or ADBV.

CONCLUSION

Results from this study are consistent with previous research suggesting that physical activity during adolescence and early adulthood is unrelated to breast density.

Attenuation-corrected fluorescence extraction for image-guided surgery in spatial frequency domain

A new approach to retrieve the attenuation-corrected fluorescence using spatial frequency-domain imaging is demonstrated. Both in vitro and ex vivo experiments showed the technique can compensate for the fluorescence attenuation from tissue absorption and scattering. This approach has potential in molecular image-guided surgery.

Age and ethnic differences in volumetric breast density in new zealand women: a cross-sectional study

Breast cancer incidence differs by ethnicity in New Zealand (NZ) with Māori (the indigenous people) women having the highest rates followed by Pakeha (people primarily of British/European descent), Pacific and Asian women, who experience the lowest rates. The reasons for these differences are unclear. Breast density, an important risk factor for breast cancer, has not previously been studied here. We used an automated system, Volpara™, to measure breast density volume from the medio-lateral oblique view of digital mammograms, by age (≤50 years and >50 years) and ethnicity (Pakeha/Māori/Pacific/Asian) using routine data from the national screening programme: age; x-ray system and mammography details for 3,091 Pakeha, 716 Māori, 170 Pacific and 662 Asian (total n = 4,239) women. Linear regression of the natural logarithm of absolute and percent density values was used, back-transformed and expressed as the ratio of the geometric means. Covariates were age, x-ray system and, for absolute density, the natural log of the volume of non-dense tissue (a proxy for body mass index). Median age for Pakeha women was 55 years; Māori 53 years; and Pacific and Asian women, 52 years. Compared to Pakeha women (reference), Māori had higher absolute volumetric density (1.09; 95% confidence interval [95% CI] 1.03-1.15) which remained following adjustment (1.06; 95% CI 1.01-1.12) and was stronger for older compared to younger Māori women. Asian women had the greatest risk of high percentage breast density (1.35; 95% CI 1.27-1.43) while Pacific women in both the ≤50 and >50 year age groups (0.78; 95% CI 0.66-0.92 and 0.81; 95% CI 0.71-0.93 respectively) had the lowest percentage breast density compared to Pakeha. As well as expected age differences, we found differential patterns of breast density by ethnicity consistent with ethnic differences seen in breast cancer risk. Breast density may be a contributing factor to NZ's well-known, but poorly explained, inequalities in breast cancer incidence.

Diffusion weighted MRI by spatiotemporal encoding: analytical description and in vivo validations

Diffusion-weighted (DW) MRI is a powerful modality for studying microstructure in normal and pathological tissues. The accuracy derived from DW MRI depends on the acquisition of quality images, and on a precise assessment of the b-values involved. Conventional DW MRI tends to be of limited use in regions suffering from large magnetic field or chemical shift heterogeneities, which severely distort the MR images. In this study we propose novel sequences based on SPatio-temporal ENcoding (SPEN), which overcome such shortcomings owing to SPEN's inherent robustness to offsets. SPEN, however, relies on the simultaneous application of gradients and radiofrequency-swept pulses, which may impart different diffusion weightings along the spatial axes. These will be further complicated in DW measurements by the diffusion-sensitizing gradients, and will in general lead to complex, spatially-dependent b-values. This study presents a formalism for analyzing these diffusion-weighted SPEN (dSPEN) data, which takes into account the concomitant effects of adiabatic pulses, of the imaging as well as diffusion gradients, and of the cross-terms between them. These analytical b-values derivations are subject to experimental validations in phantom systems and ex vivo spinal cords. Excellent agreement is found between the theoretical predictions and these dSPEN experiments. The ensuing methodology is then demonstrated by in vivo mapping of diffusion in human breast - organs where conventional k-space DW acquisition methods are challenged by both field and chemical shift heterogeneities. These studies demonstrate the increased robustness of dSPEN vis-à-vis comparable DW echo planar imaging, and demonstrate the value of this new methodology for medium- or high-field diffusion measurements in heterogeneous systems.

[Physiopathology, diagnosis and treatment of breast cancer]

The organised screening of breast cancer, the identification of the type of lesion and the staging determine the treatment plan for this disease. The most common cancer to affect women in France and in Europe, it represents 1/3 of cancers in women and 1/4 of all cancers.

Ultra high spatial and temporal resolution breast imaging at 7T

There is a need to obtain higher specificity in the detection of breast lesions using MRI. To address this need, Dynamic Contrast-Enhanced (DCE) MRI has been combined with other structural and functional MRI techniques. Unfortunately, owing to time constraints structural images at ultra-high spatial resolution can generally not be obtained during contrast uptake, whereas the relatively low spatial resolution of functional imaging (e.g. diffusion and perfusion) limits the detection of small lesions. To be able to increase spatial as well as temporal resolution simultaneously, the sensitivity of MR detection needs to increase as well as the ability to effectively accelerate the acquisition. The required gain in signal-to-noise ratio (SNR) can be obtained at 7T, whereas acceleration can be obtained with high-density receiver coil arrays. In this case, morphological imaging can be merged with DCE-MRI, and other functional techniques can be obtained at higher spatial resolution, and with less distortion [e.g. Diffusion Weighted Imaging (DWI)]. To test the feasibility of this concept, we developed a unilateral breast coil for 7T. It comprises a volume optimized dual-channel transmit coil combined with a 30-channel receive array coil. The high density of small coil elements enabled efficient acceleration in any direction to acquire ultra high spatial resolution MRI of close to 0.6 mm isotropic detail within a temporal resolution of 69 s, high spatial resolution MRI of 1.5 mm isotropic within an ultra high temporal resolution of 6.7 s and low distortion DWI at 7T, all validated in phantoms, healthy volunteers and a patient with a lesion in the right breast classified as Breast Imaging Reporting and Data System (BI-RADS) IV.

Resource security impacts men's female breast size preferences

It has been suggested human female breast size may act as signal of fat reserves, which in turn indicates access to resources. Based on this perspective, two studies were conducted to test the hypothesis that men experiencing relative resource insecurity should perceive larger breast size as more physically attractive than men experiencing resource security. In Study 1, 266 men from three sites in Malaysia varying in relative socioeconomic status (high to low) rated a series of animated figures varying in breast size for physical attractiveness. Results showed that men from the low socioeconomic context rated larger breasts as more attractive than did men from the medium socioeconomic context, who in turn perceived larger breasts as attractive than men from a high socioeconomic context. Study 2 compared the breast size judgements of 66 hungry versus 58 satiated men within the same environmental context in Britain. Results showed that hungry men rated larger breasts as significantly more attractive than satiated men. Taken together, these studies provide evidence that resource security impacts upon men’s attractiveness ratings based on women’s breast size.

Breast calcification imaging

Breast calcifications are a common mammographic finding, present on 86% of images. Although usually benign, they also can be malignant. Characteristics such as their size, shape, number, distribution pattern, location, density, and other findings help determine their pathology. The American College of Radiology's BI-RADS assessment categories and Appropriateness Criteria guidelines help radiologists and other physicians determine appropriate action when calcifications are discovered. This article reviews breast anatomy, the classification of calcifications, malignant vs benign characteristics, imaging techniques for calcifications, and biopsy procedures.

Bra-breast forces generated in women with large breasts while standing and during treadmill running: Implications for sports bra design

This study aimed to determine the bra-breast forces generated in women with large breasts while these women wore different levels of breast support during both upright standing and treadmill running. The mean bilateral vertical component of the bra-breast force in standing was 11.7 ± 4.6 N, whereas during treadmill running the mean unilateral bra-breast force was 8.7 ± 6.4 N and 14.7 ± 10.3 N in the high and low support conditions, respectively. Furthermore, breast mass was significantly correlated with vertical breast displacement (R(2) = 0.62) in the high support condition. The wide range of breast masses of women with large breasts is an important consideration for designers of sports bras to ensure these bras can reduce force generation and breast discomfort by providing a high level of breast support while these women participate in physical activity.

Correction of breast asymmetries with implants

The article presents the indications and results of augmentation mammaplasty in 121 female patients with breast asymmetry. Inframammary and periareolar incisions were used in the surgical intervention. Subglandular, submuscular and dual plane techniques were used in creating the implant pocket. The obtained results and the advantages and disadvantages of each technique are discussed.

Clinical accuracy and reproducibility of Portrait 3D Surgical Simulation Platform in breast augmentation

BACKGROUND

Three-dimensional (3D) digital photography uses integrated image capture technology and rendering software to create 3D models. Volumetric measurements project simulated post-operative images prior to breast augmentation.

OBJECTIVES

To evaluate the accuracy and reproducibility of breast volume measurements using the Portrait 3D Surgical Simulation Platform (Axis Three, Boston, Massachusetts).

METHODS

Twenty-two patients underwent breast augmentation. 3D volumetric imaging analysis was performed by two independent observers preoperatively and at 6 weeks postoperatively. Simulated volumes were compared to actual implant volume using the Student's t test. Intra-observer reliability was evaluated by measuring internal consistency (Cronbach and 95% confidence interval [CI]) and test-retest reliability (intraclass correlation coefficient [ICC]) from the two observers' calculated volumes.

RESULTS

Half (n = 11) of the patients received silicone implants and half saline; all were placed in the submuscular plane through an inframammary incision. No difference in volume estimation in preoperative or postoperative images (P = .49 and P = .14; and P = 1.0 and P = .37, in right and left breasts, respectively) was observed. The test-retest reliability between observers was excellent (ICC, 0.98; P < .001) and Cronbach's value (0.99; 95% CI 0.97-0.99; P < .001) demonstrated an excellent correlation. Regarding accuracy, difference in volume estimation between actual and simulated volumes varied between 0 to 106 mL (0 - 30%), with an absolute mean difference of 12.2% (42.5 mL).

CONCLUSIONS

The Portrait 3D breast imaging system provides a highly reproducible 3D tool for measuring breast volume and simulating breast augmentation. Accuracy of the 3D models can vary up to 30% (mean 12.2%). This variability should be accounted for when using this technology to visually communicate with patients.

Planning augmentation mammaplasty of breast asymmetries

The article presents a modern approach to planning augmentation mammoplasty of breast asymmetries. The preoperative planning includes anthropomorphic measurements to assess the breast anatomy; selection of suitable implants based on mathematical calculations; choice of operative technique that best suits the individual characteristics of the patient. Preoperative planning was done in 220 cases of women with breast asymmetries requesting augmentation mammoplasty during the period 2000-2011. Augmentation alone, augmentation with simultaneous mastopexy, and augmentation with reconstruction of the breast base are performed. The postoperative results obtained shape, volume and symmetry, are monitored during regular postoperative examinations. The significance of preoperative planning in augmentation mammoplasty of breast asymmetries is discussed.

Virtual navigator 3D panoramic for breast examination

Breast examination both for screening and second level of investigation has spread worldwide, due to increased breast cancer awareness. Thus, different diagnostic imaging technologies emerged in breast application. Ultrasound (US), a real-time examination, non-invasive, cost effective, ideal also for repetitive follow-up and able to give information about anatomy, hemodynamics and tissue stiffness, plays an important role in breast diagnostics. The present work describes the innovative three-dimensional (3D) Panoramic (Pan) tool of Virtual Navigator technology for real-time fusion imaging of breast 3D US volumes with bi-dimensional US scans. A Motion Control Sensor enables the correction of the examined subject's movements. Data about fusion precision and system performances will be presented regarding tests in vitro, in ex-vivo and in vivo.

Mammographic breast density patterns among a group of women in sub Saharan Africa

INTRODUCTION

Mammographic breast density is a measure of parenchymal breast patterns on film and in part a marker of cumulative exposure to oestrogen. The risk of breast cancer for women with increased density is up to six fold more than in women with less dense tissues. The pattern of mammographic breast density among Ugandan women is not known.

OBJECTIVE

To establish these as a contribution to baseline data.

METHODS

A cross sectional descriptive study that enrolled women presenting for mammography at the national referral hospital radiology department. Breast densities were scored using the BI-RADS categories. IRB approval was obtained.

RESULTS

Of the 190 women enrolled, 178 were scored, of those scored 10 (5.3%) had extremely dense breasts (grade IV) and 39 (20.5%) had heteregenous ones (grade III). The rest 129 (67.9%) had scattered fibroglandular or fat densities (Grades I & II). Most of the women were young 45.8 ± 12.5 years The majority had normal or benign mammographic findings and all were non pregnant.

CONCLUSION

Mammographic densities in this Ugandan population appear to be of low grade. The pattern established here is markedly different from findings in other studies that indicated much higher proportions for high dense tissues in other races. Mammographic interpretation of films could therefore be easier.

A phase 2 trial of once-weekly hypofractionated breast irradiation: first report of acute toxicity, feasibility, and patient satisfaction

PURPOSE

To report on early results of a single-institution phase 2 trial of a 5-fraction, once-weekly radiation therapy regimen for patients undergoing breast-conserving surgery (BCS).

METHODS AND MATERIALS

Patients who underwent BCS for American Joint Committee on Cancer stage 0, I, or II breast cancer with negative surgical margins were eligible to receive whole breast radiation therapy to a dose of 30 Gy in 5 weekly fractions of 6 Gy with or without an additional boost. Elective nodal irradiation was not permitted. There were no restrictions on breast size or the use of cytotoxic chemotherapy for otherwise eligible patients. Patients were assessed at baseline, treatment completion, and at first posttreatment follow-up to assess acute toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and quality of life (European Organization for Research and Treatment of Cancer QLQ-BR23).

RESULTS

Between January and September 2011, 42 eligible patients underwent weekly hypofractionated breast irradiation immediately following BCS (69.0%) or at the conclusion of cytotoxic chemotherapy (31.0%). The rates of grade ≥2 radiation-induced dermatitis, pain, fatigue, and breast edema were 19.0%, 11.9%, 9.5%, and 2.4%, respectively. Only 1 grade 3 toxicity-pain requiring a course of narcotic analgesics-was observed. One patient developed a superficial cellulitis (grade 2), which resolved with the use of oral antibiotics. Patient-reported moderate-to-major breast symptoms (pain, swelling, and skin problems), all decreased from baseline through 1 month, whereas breast sensitivity remained stable over the study period.

CONCLUSIONS

The tolerance of weekly hypofractionated breast irradiation compares well with recent reports of daily hypofractionated whole-breast irradiation schedules. The regimen appears feasible and cost-effective. Additional follow-up with continued accrual is needed to assess late toxicity, cosmesis, and disease-specific outcomes.

Evidence for genetic variation in human mate preferences for sexually dimorphic physical traits

Intersexual selection has been proposed as an important force in shaping a number of morphological traits that differ between human populations and/or between the sexes. Important to these accounts is the source of mate preferences for such traits, but this has not been investigated. In a large sample of twins, we assess forced-choice, dichotomous mate preferences for height, skin colour, hair colour and length, chest hair, facial hair, and breast size. Across the traits, identical twins reported more similar preferences than nonidentical twins, suggesting genetic effects. However, the relative magnitude of estimated genetic and environmental effects differed greatly and significantly between different trait preferences, with heritability estimates ranging from zero to 57%.

Patient-to-patient variation of susceptibility-induced B₀ field in bilateral breast MRI

PURPOSE

To evaluate intersubject variability of susceptibility-induced static field inhomogeneity in breast and to assess effectiveness of whole-body high-order shimming applied to bilateral breast.

MATERIALS AND METHODS

A fast, computationally efficient method to calculate susceptibility-induced static field from anatomical images was developed. The method was validated against the conventional multiecho B(0) mapping method and was used to generate data for linear and higher-order shim simulation on 13 volunteers.

RESULTS

Most volunteers showed a significant anterior-posterior B(0) gradient. The majority of the subjects also exhibited a statistically significant left-right gradient. The second- and third-order shimming provided only minor (<5% each) improvement in B(0) homogeneity.

CONCLUSION

The shape of the air-tissue boundary determines most of the observed B(0) distribution in bilateral breast. Despite significant variability among subjects, a common feature traceable to generic anatomy exists in the linear gradient. Nonlinear variation of susceptibility-induced B(0) field occurs over a relatively short length scale and is likely best shimmed by slice-dependent or localized shimming.

Measuring volumetric change after augmentation mammaplasty using a three-dimensional scanning technique: an innovative method

BACKGROUND

Measurement of volumetric change after augmentation mammaplasty is of great significance to plastic surgeons. This study aimed to introduce a new method using a three-dimensional (3D) scanning technique to measure volumetric change after augmentation mammaplasty.

METHODS

Preoperative 3D scans of 10 breasts were included in the study. A simulated postoperative breast scan was constructed using software. The true value of volumetric change was calculated. Volumetric change was measured and repeated 10 times by the traditional method and the new method. One investigator used the traditional method, and two investigators used the new method. The difference from the true value between the two methods and the intraclass coefficient (ICC) for each method was evaluated. Comparison of agreement with the true value and comparison of agreement using the new method between the two investigators were made using a Bland-Altman analysis.

RESULTS

The mean breast volumetric change was 256.1 ± 61.1 ml for the new method, 281.9 ± 73.7 ml for the traditional method, and 256.0 ± 61.0 ml for the true value. The difference from the true value for the traditional method was significantly greater than for the new method. The ICC was 0.9999 for the new method and 0.993 for the traditional method. Bland-Altman analysis showed a 95 % confidence interval (CI) of -40.9 to 92.7 ml for the traditional method and -0.9 to 1.2 ml for the new method. Comparison of agreement between investigators 1 and 2 showed a 95 % CI of -0.9 to 1.0 ml. The limits of agreement were ±1.0 ml.

CONCLUSIONS

The proposed new method can provide excellent accuracy, repeatability, and reproducibility in measuring volumetric change after augmentation mammaplasty using a 3D scanning technique.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article.

Endoscopically assisted aesthetic augmentation of tuberous breasts and fat grafting to correct the double bubble

BACKGROUND

Treatment of tuberous breasts types 1 and 2 must deal with the problem of the pseudo-double bubble in the primitive inframammary fold and also must release the constrictive ring. Two techniques currently are used to overcome these problems, but neither is entirely satisfactory. The first technique, in which the approach is via the primitive inframammary fold, leaves significant scarring when the lower poles expand. The second technique, in which the approach is periareolar, considerably reduces the area's sensitivity. This report presents a new endoscopically assisted technique with an axillary approach designed to solve these problems.

METHODS

Between 2005 and 2010, 68 patients (ages 18-42 years) underwent surgery. The intervention was bilateral in 57 and unilateral in 11 of these patients. All cases involved tuberous breasts types 1 and 2 (Grolleau's classification). The augmentation involves a transaxillary subfascial endoscopic approach, opening of the fascia at the primitive inframammary fold, and releasing of the constricting ring to enable the breast to expand, followed by implantation of an anatomic prosthesis to add volume to the lower quadrants. If the pseudo-double bubble appears, fat grafting is applied during the same surgical procedure.

RESULTS

The results were reported to be highly satisfactory both by the patients and by the independent medical team. For six patients (8.82 %), fat grafting had to be repeated in the double bubble. No major complications were reported.

CONCLUSION

The endoscopically assisted subfascial breast augmentation technique obtains highly satisfactory results in tuberous breasts types 1 and 2 (Grolleau's classification). The single scar is concealed in the axillary fold.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article.

Prediction of breast resection weight in reduction mammaplasty based on 3-dimensional surface imaging

Prediction of resection weight (RW) in reduction mammaplasty is helpful in achieving breast symmetry and in fulfilling the stringent reimbursement requirements of health insurance companies. Current breast volume estimations are largely based on surgeon's experience, which are partially unreliable and often cumbersome to obtain. Therefore, this study aims to develop a formula to predict RW based on 3D surface imaging. A total of 68 breasts were treated with bilateral T-scar, and 40 breasts were treated with bilateral or unilateral vertical-scar reduction mammaplasty. Linear distances and volume measurements were assessed 3-dimensionally preoperatively and 6 months postoperatively. Significant correlations between the RW and the calculated preoperative breast volume (ρ = 0.804) and the sternal notch to nipple distance (ρ = 0.839) were found in both techniques (P < .001). Regression equations with the RW were performed to derive prediction formulas. Surgeons may benefit from the formulas in terms of improvement in preoperative planning, dealing with insurance coverage questions, and optimizing patient consultation.

Body image and body type preferences in St. Kitts, Caribbean: a cross- cultural comparison with U.S. samples regarding attitudes towards muscularity, body fat, and breast size

We investigated body image in St. Kitts, a Caribbean island where tourism, international media, and relatively high levels of body fat are common. Participants were men and women recruited from St. Kitts (n = 39) and, for comparison, U.S. samples from universities (n = 618) and the Internet (n = 438). Participants were shown computer generated images varying in apparent body fat level and muscularity or breast size and they indicated their body type preferences and attitudes. Overall, there were only modest differences in body type preferences between St. Kitts and the Internet sample, with the St. Kitts participants being somewhat more likely to value heavier women. Notably, however, men and women from St. Kitts were more likely to idealize smaller breasts than participants in the U.S. samples. Attitudes regarding muscularity were generally similar across samples. This study provides one of the few investigations of body preferences in the Caribbean.

Determinants of breast appearance and aging in identical twins

BACKGROUND

Appearance, aging, and disorders of the breast are multifactorial. There are intrinsic, patient-specific characteristics, such as breast growth during puberty and propensity for breast cancer, which are primarily inherited. There are also environmental factors, which can be potentially controlled. Monozygotic twins provide an excellent research opportunity to examine the role of extrinsic factors in subjects with identical genetic predispositions.

OBJECTIVES

The authors investigate the role and significance of various environmental and acquired factors on breast aesthetics.

METHODS

Identical female twins were recruited during the Twins Days Festival in Twinsburg, Ohio, in 2009 and 2010. After consent was obtained, enrolled subjects completed a comprehensive survey on their medical and personal history. Standardized digital photographs were taken by medical photographers. Sixteen aesthetic breast features were subjectively rated by 6 plastic surgery residents blinded to the survey results. These ratings were then analyzed against survey data to determine the significance of different exogenous factors on breast appearance.

RESULTS

A total of 161 pairs of identical female twins (n = 322) with a mean (SD) age of 47.6 (14.5) years were recruited. Twins who moisturized their skin daily had significantly fewer rhytids (P = .002). Twins who received hormone replacement therapy after menopause had more attractive breast shape, size, projection, areolar shape, and areolar size (P < .03). However, twins who had a higher body mass index, greater number of pregnancies, and larger cup sizes had significantly less attractive breasts (P < .05). Twins who smoked cigarettes and consumed alcohol also had significantly less attractive breasts (P < .05). Twins who breastfed had less attractive areolar size and shape but better skin quality than their counterparts who never breastfed (P < .03). Finally, there was a significantly higher incidence of breast pain in twins who primarily slept on their sides compared with twins who primarily slept on their backs (P < .008).

CONCLUSIONS

This study implicates several environmental factors that significantly affect the aesthetic quality of breasts.

Three-dimensional evaluation of breast augmentation and the influence of anatomic and round implants on operative breast shape changes

BACKGROUND

Currently, postoperative outcome analysis in breast augmentation is essentially subjective, and objective evaluation of treatment efficacy is lacking. This study evaluates the influence of anatomic and round implant parameters on breast contour changes after subpectoral breast augmentation using three-dimensional (3D) surface imaging.

METHODS

3D surface breast scans of 17 patients (34 breasts) undergoing subpectoral breast augmentation with round implants and of ten patients (20 breasts) receiving anatomic implants via an axillary approach under endoscopic assistance or a submammary fold incision were obtained before and 6 months postoperatively. 3D linear distance, breast volume, and surface measurement were correlated with the implanted round and anatomic implant parameters, and the resulting breast shape changes were evaluated.

RESULTS

Total breast volume changed in correlation with the implant size (2.4% difference; r=0.894; p<0.001). Implant volume and type influence the nipple-to-inframammary fold distance (N-IMF). Every inserted 100 ml implant volume enlarges the N-IMF distance by 0.8 cm (anatomic>round; p=0.01). Postoperatively, the IMF dropped by an average of 1.3 cm for round implants and by 1.1 cm for anatomic implants, without relevant differences between the applied surgical incision and the selected implants (p>0.05). Breast projection increased significantly more with anatomic implants (2.4 cm) than with round implants (1.7 cm) (p=0.01). The breast projection increase was 22% less than expected for round implants and 25% less than expected for anatomic implants based on the manufacturer implant parameters (p<0.01), without essential differences regarding the surgical incision.

CONCLUSIONS

3D breast shape changes induced by round and anatomic implants after subpectoral augmentation mammaplasty are objectively documented including breast projection, volume, and N-IMF distance changes. 3D surface imaging may have a potential clinical contribution to objective surgical outcome research.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Fast 3-d tomographic microwave imaging for breast cancer detection

Microwave breast imaging (using electromagnetic waves of frequencies around 1 GHz) has mostly remained at the research level for the past decade, gaining little clinical acceptance. The major hurdles limiting patient use are both at the hardware level (challenges in collecting accurate and noncorrupted data) and software level (often plagued by unrealistic reconstruction times in the tens of hours). In this paper we report improvements that address both issues. First, the hardware is able to measure signals down to levels compatible with sub-centimeter image resolution while keeping an exam time under 2 min. Second, the software overcomes the enormous time burden and produces similarly accurate images in less than 20 min. The combination of the new hardware and software allows us to produce and report here the first clinical 3-D microwave tomographic images of the breast. Two clinical examples are selected out of 400+ exams conducted at the Dartmouth Hitchcock Medical Center (Lebanon, NH). The first example demonstrates the potential usefulness of our system for breast cancer screening while the second example focuses on therapy monitoring.

A new mammography dosimetric phantom

Breast phantoms produced with tissue-equivalent materials are used in an attempt to simulate glandular and adipose tissues, in terms of X-ray attenuation and density. In this work, a set of breast tissue-equivalent phantoms (BTE phantoms) with semicircular shapes of different thicknesses and compositions were produced. Such phantoms may be used in the measurement of the incident air kerma (K(i)) and the mean glandular dose (D(G)) delivered to patients undergoing mammography. To characterise the materials used to produce the phantoms, a series of 17-keV X-ray attenuation coefficient measurements were performed. The carbon-nitrogen-hydrogen elemental composition and the densities of the tissue-equivalent materials were also determined and compared with values available in the literature. Linear attenuation coefficients of 0.724 and 0.923 cm(-1) were determined, respectively, for adipose and glandular tissues. Such values agree with data available in the literature. On the basis of the results obtained in this work, it is suggested that BTE phantoms are used instead of polymethyl methacrylate phantoms to select exposure parameters (kV, mAs and target/filter combination) specific for breast glandularities from 0 to 50 % in the optimisation of doses in mammography.

Comparison of algorithms for out-of-plane artifacts removal in digital tomosynthesis reconstructions

Digital tomosynthesis is a method of limited angle reconstruction of tomographic images produced at variable heights, on the basis of a set of angular projections taken in an arc around human anatomy. Reconstructed tomograms from unprocessed original projection images, however, are invariably affected by tomographic noise such as blurred images of objects lying outside the plane of interest and superimposed on the focused image of the fulcrum plane. The present work investigates the performance of two approaches for generation of tomograms with a reduced noise: a generalised post-processing method, based on constructing a noise mask from all planes in the reconstructed volume, and its subsequent subtraction from the in-focus plane and a filtered Multiple Projection Algorithm. The comparison between the two algorithms shows that the first method provides reconstructions with very good quality in case of high contrast features, especially for those embedded into a heterogeneous background.

Genetic variants associated with breast size also influence breast cancer risk

BACKGROUND

While some factors of breast morphology, such as density, are directly implicated in breast cancer, the relationship between breast size and cancer is less clear. Breast size is moderately heritable, yet the genetic variants leading to differences in breast size have not been identified.

METHODS

To investigate the genetic factors underlying breast size, we conducted a genome-wide association study (GWAS) of self-reported bra cup size, controlling for age, genetic ancestry, breast surgeries, pregnancy history and bra band size, in a cohort of 16,175 women of European ancestry.

RESULTS

We identified seven single-nucleotide polymorphisms (SNPs) significantly associated with breast size (p<5.10(-8)): rs7816345 near ZNF703, rs4849887 and (independently) rs17625845 flanking INHBB, rs12173570 near ESR1, rs7089814 in ZNF365, rs12371778 near PTHLH, and rs62314947 near AREG. Two of these seven SNPs are in linkage disequilibrium (LD) with SNPs associated with breast cancer (those near ESR1 and PTHLH), and a third (ZNF365) is near, but not in LD with, a breast cancer SNP. The other three loci (ZNF703, INHBB, and AREG) have strong links to breast cancer, estrogen regulation, and breast development.

CONCLUSIONS

These results provide insight into the genetic factors underlying normal breast development and show that some of these factors are shared with breast cancer. While these results do not directly support any possible epidemiological relationships between breast size and cancer, this study may contribute to a better understanding of the subtle interactions between breast morphology and breast cancer risk.

Subfascial breast augmentation: is there any advantage over the submammary plane?

Subfascial (SF) breast augmentation has been proposed as an alternative to placement of a breast prosthesis in a subpectoral (SP) or direct submammary (SM) plane, producing advantages over both techniques. This study compares complication rates in 200 SF-placed implants with 83 SM implants, undertaken over a 51-month period by a single surgeon. No statistical difference was found in the complication rate or patient satisfaction of one technique over the other. No clinical advantage can be demonstrated by placing breast prostheses behind the pectoral fascia compared to directly behind the breast.

Improving the longevity and results of mastopexy and breast reduction procedures: reconstructing an internal breast support system with biocompatible mesh to replace the supporting function of the ligamentous suspension

Background

The reasons for recurrent ptosis in mastopexy and breast reduction procedures are twofold. First, available surgical techniques do not reconstruct the normal breast anatomy responsible for maintaining breast shape. Second, in many instances the techniques rely on atrophied tissue to provide long-term support. The discovery in 1997 of the ligamentous suspension (the supporting system of the breast) gave rise to the concept that reconstruction of this anatomical structure was needed to ensure a sustained postoperative result. Applying the latest knowledge regarding the structural and vascular anatomy of the breast in the surgical technique and utilizing material other than atrophied breast tissue enabled us to prevent the recurrence of breast ptosis.

Methods

A surgical technique was developed to replace the supportive function of a failed ligamentous suspension in 112 patients with ptotic breasts. This was done by reconstructing an internal breast-supporting system (IBSS) with biocompatible mesh.

Results

Satisfactory breast shape, nipple projection, and upper breast fullness was obtained with this technique in mastopexy patients with moderate-sized ptotic breasts. In patients with larger breasts good results were obtained with a simultaneous breast reduction. The longest follow-up is 6 years 3 months.

Conclusions

With this technique recurrent breast ptosis can be prevented in mastopexy and breast reduction procedures. The results are such that it eliminates the need for silicone prostheses to obtain satisfactory upper-breast fullness. The surgical technique is especially indicated in patients with skin of poor quality or patients with high expectations.

Evaluating elastic properties of heterogeneous soft tissue by surface acoustic waves detected by phase-sensitive optical coherence tomography

The combined use of surface acoustic wave (SAW) and phase-sensitive optical coherence tomography (PhS-OCT) is useful to evaluate the elasticity of layered biological tissues, such as normal skin. However, the pathological tissue is often originated locally, leading to the alternation of mechanical properties along both axial and lateral directions. We present a feasibility study on whether the SAW technique is sensitive to detect the alternation of mechanical property along the lateral direction within tissue, which is important for clinical utility of this technique to localize diseased tissue. Experiments are carried out on purposely designed tissue phantoms and ex vivo chicken breast samples, simulating the localized change of elasticity. A PhS-OCT system is employed not only to provide the ultra-high sensitive measurement of the generated surface waves on the tissue surface, but also to provide the real time imaging of the tissue to assist the elasticity evaluation of the heterogeneous tissue. The experimental results demonstrate that with PhS-OCT used as a pressure sensor, the SAW is highly sensitive to the elasticity change of the specimen in both vertical and lateral directions with a sensing depth of ∼5 mm with our current system setup, thus promising its useful clinical applications where the quantitative elasticity of localized skin diseases is needed to aid in diagnosis and treatment.

Ultrasound identification of nerve cords in the infraclavicular fossa: a clinical study

BACKGROUND

This study aimed to analyze nerve trunk anatomy in the infraclavicular fossa and to correlate these data with the most common anthropometric parameters.

METHODS

A Mylab 30 Gold (Esaote) and the linear transducer LA523 (7.5 MHz frequency) were used. The probe was oriented according to a parasagittal plane, parallel to the lateral chest wall and immediately medial to the coracoid process underneath the clavicle. Measurements included the distance between the artery and the cutaneous surface (mm) and the apical corner of the ultrasound image (mm), the number of identified nervous cords and their position related to the axillary artery, and the position and number of axillary veins. Sex, age, height, weight, body mass index (BMI), biceps girth, and breast size were recorded. Statistical analysis included calculation of linear Pearson correlation coefficient and Student's t test.

RESULTS

Two hundred and two consecutive patients were enrolled. The position of the three cords was highly variable around the artery. In a small but significant percentage of patients (8.9%), the medial and the lateral cords were located together at the top of the artery. The visibility of the trunks and the distance between the upper part of the artery and the apical corner of the ultrasound image correlated with anthropometric characteristics. The vein position with respect to the artery and nerves was markedly variable.

CONCLUSION

Sono-anatomic study of the infraclavicular region adds important data that is useful when conducting nerve blocks to improve safety and likelihood of success.

Three-dimensional in silico breast phantoms for multimodal image simulations

Anatomic simulators have provided researchers with the realistic objects needed to develop and evaluate medical imaging approaches. Today we have new insights into the cellular biology of breast tissues that is driving many new targeted diagnostic and therapeutic approaches, including molecular imaging. We report on our initial efforts to build a scalable framework for the construction of realistic 3-D in silico breast phantoms (ISBP) capable of leveraging existing knowledge and yet adaptable to fully integrate future discoveries. The ISBP frames are developed with scalable anatomical shapes and morphologic features as adapted from a rich literature on this topic. Frames are populated with tissue subtypes essential for imaging and object contrast functions are assigned. These data can be resampled to match the intrinsics scales of various imaging modalities; we explore mammography, sonography and computed tomography. Initial comparisons between simulated and clinical images demonstrate reasonable agreement and provides guidance for future development of a more realistic ISBP. An end-to-end simulation of breast images is described to demonstrate techniques for including stochastic variability and deterministic physical principles on which image formation is based.

Classification of terahertz-pulsed imaging data from excised breast tissue

We investigate the efficacy of using data reduction techniques to aid classification of terahertz (THz) pulse data obtained from tumor and normal breast tissue. Fifty-one samples were studied from patients undergoing breast surgery at Addenbrooke's Hospital in Cambridge and Guy's Hospital in London. Three methods of data reduction were used: ten heuristic parameters, principal components of the pulses, and principal components of the ten parameter space. Classification was performed using the support vector machine approach with a radial basis function. The best classification accuracy, when using all ten components, came from using the principal components on the pulses and principal components on the parameter, with an accuracy of 92%. When less than ten components were used, the principal components on the parameter space outperformed the other methods. As a visual demonstration of the classification technique, we apply the data reduction/classification to several example images and demonstrate that, aside from some interpatient variability and edge effects, the algorithm gives good classification on terahertz data from breast tissue. The results indicate that under controlled conditions data reduction and SVM classification can be used with good accuracy to classify tumor and normal breast tissue.

Possible effects of insulin-like growth factor-I, IGF-binding protein-3 and IGF-1/IGFBP-3 molar ratio on mammographic density: a cross-sectional study

The purpose of this study was to examine the possible effects of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density and assess whether this relationship was similar in subgroups of pre- and postmenopausal women. A group of 341 Italian women of childbearing age or naturally postmenopausal who had performed mammographic examination at the section of radiology of our department a maximum three months prior to recruitment were enrolled. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels and IGF-1/IGFBP-3 molar ratio was calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). To assess the association between mammographic density and IGF-1, IGFBP-3 and Molar ratio Student's t-test was employed before and after stratified by menopausal status. The analysis of the relationship between mammographic density and plasma levels of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group whereas IGFBP-3 showed similar values in both groups (DB and NDB). After stratification of the study population by menopausal status, no association was found. Our study provides strong evidence of a crude association between breast density, and plasma levels of IGF-1 and molar ratio. IGF-1 and molar ratio might increase mammographic density and thus the risk of developing breast cancer.

Mammographic features in infertile women as a potential risk for breast cancer: a preliminary study

The purpose of the present study was to evaluate breast mammographic features, particularly mammographic density in a selected population of infertile women and to assess if these women should be considered at higher risk for breast cancer. The prevalence of female infertility in Western countries is approximately 10-15% and since causes affecting the female are involved in 35-40%, concerns have developed about the future health of these women, specifically whether infertility could represent a risk factor for future cancer development. Moreover, infertility is now often treated with medication and procedures that could modify the hormonal environment and be cofactors in the cellular changes towards cancer development. Mammographic breast density is a useful marker for breast cancer risk and breast density is considered one of the strongest risk factors for breast cancer. Breast density is associated with known breast cancer risk factors such as reproductive and menstrual factors including serum estrogen and progesterone concentrations. In Italy the National Federation for Breast Cancer (FONCAM) guidelines suggest the usefulness of mammography from 35 years of age for women who undergo infertility hormone therapy (FONCAM Guidelines, 2005). According to this recommendation 294 women aged > or = 35, with primary infertility, sent to our breast service before joining an IVF program were recruited and then underwent clinical examination and X-ray mammography. Women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Univariate analysis was employed to evaluate if there was an association between mammographic density and other risk factors. Evaluation of mammographic features showed the presence of BI-RADs C and D in the sample of 200 (68%) patients with DB and in 94 (32%) patients with NDB BI-RADS A and B. Univariate analysis showed that there were no statistically significant differences between the groups BD and NDB as regards age at mammography, age at menarche, BMI and family history for breast cancer, while ovulatory etiology of infertility was found to be associated with high mammographic density (p < 0.05). In conclusion, bearing in mind that 68% of our study sample had high breast density, we can assume that patients with primary infertility might represent a group at high risk for breast cancer, particularly if infertility is due to an ovulatory factor. We suggest breast screening from the age of 35 in infertile patients who undergo treatment with fertility drugs in accordance with FONCAM recommendations. This might allow the identification of higher risk patients who need more closely monitored breast examinations.