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Alalawi Y, Alamrani SAS, Alruwaili OM, Alzahrani IF, Al Madshush AM. The Relationship Between Breast Density and Breast Cancer Surgical Outcomes: A Systematic Review. Cureus 2024; 16:e57265. [PMID: 38686256 PMCID: PMC11057672 DOI: 10.7759/cureus.57265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
This study aims to investigate the relationship between mammographic breast density and the surgical outcomes of breast cancer. PubMed, SCOPUS, Web of Science, Science Direct, and the Wiley Library were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. Our results included ten studies with a total of 5017 women diagnosed with breast cancer. The follow-up duration ranged from 1 year to 15.1 years. Eight out of the twelve included studies reported that low mammographic breast density was significantly associated with no local recurrence, metachronous contralateral breast cancer, and fewer challenges in the preoperative and intraoperative phases. On the other hand, four studies reported that mammographic breast density is not linked to disease recurrence, survival, re-excision, or an incomplete clinical and pathological response. There is a significant association between low mammographic breast density and reduced challenges in the preoperative and intraoperative phases, as well as no local recurrence and fewer mastectomy cases. However, the link between mammographic breast density and disease recurrence, survival, re-excision, and incomplete clinical and pathological response is less clear, with some studies reporting no significant association. The findings suggest that mammographic breast density may play a role in certain aspects of breast cancer outcomes, but further research is needed to fully understand its impact.
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Affiliation(s)
- Yousef Alalawi
- Department of Surgery, King Salman Armed Forces Hospital in the North-Western Region, Tabuk, SAU
| | | | - Omar M Alruwaili
- Department of Surgery, King Salman Armed Forces Hospital in the North-Western Region, Tabuk, SAU
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2
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Salazar AS, Rakhmankulova M, Simon LE, Toriola AT. Chemoprevention Agents to Reduce Mammographic Breast Density in Premenopausal Women: A Systematic Review of Clinical Trials. JNCI Cancer Spectr 2021; 5:pkaa125. [PMID: 33554041 PMCID: PMC7853173 DOI: 10.1093/jncics/pkaa125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background Higher mammographic breast density (MBD) is associated with an increased risk of breast cancer when compared with lower MBD, especially in premenopausal women. However, little is known about the effectiveness of chemoprevention agents in reducing MBD in premenopausal women without a history of breast cancer. Findings from this review should provide insight on how to target MBD in breast cancer prevention in premenopausal women with dense breasts. Methods We searched 9 electronic databases for clinical trials in English, Spanish, French, or German published until January 2020. Articles evaluating the association of pharmacological agents and MBD were included. Data were extracted on methods, type and dose of intervention, outcomes, side effects, and follow up. Quality of the studies was assessed using the US Preventive Services Task Force criteria. Results We identified 7 clinical trials evaluating the associations of 6 chemoprevention agents with changes in MBD in premenopausal women without history of breast cancer. The studies evaluated selective estrogen-receptor modulators (n = 1); gonadotropin-releasing hormone agonists (n = 2); isoflavones (n = 1); vitamin D (n = 1); and Boswellia, betaine, and mayo-inositol compound (n = 1). Hormonal interventions were associated with net reductions in percent density (tamoxifen [13.4%], leuprolide acetate [8.9%], and goserelin [2.7%]), whereas nonhormonal (vitamin D and isoflavone) interventions were not. However, MBD returned to preintervention baseline levels after cessation of gonadotropin-releasing hormone agonists. Conclusions A limited number of chemoprevention agents have been shown to reduce MBD in premenopausal women. Identification of new and well-tolerated chemoprevention agents targeting MBD and larger studies to confirm agents that have been studied in small trials are urgent priorities for primary breast cancer prevention in premenopausal women with dense breasts.
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Affiliation(s)
- Ana S Salazar
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Malika Rakhmankulova
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Laura E Simon
- Bernard Becker Medical Library, Washington University School of Medicine, St Louis, MO, USA
| | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
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3
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Chang JF, Huang CS, Chang RF. Automated whole breast segmentation for hand-held ultrasound with position information: Application to breast density estimation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105727. [PMID: 32916544 DOI: 10.1016/j.cmpb.2020.105727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Women with higher breast densities have a relatively higher risk to be diagnosed with breast cancer. Hand-held ultrasound (HHUS) can provide precise screening results and detect masses in dense breasts. However, its lack of position information and automatic extraction of breast area hinder the implementation of density estimation. To facilitate reliable breast density evaluation, this study proposed an upgraded version of our whole-breast ultrasound (WBUS) system, which not only can provide precise position information, but also can extract precise breast area automatically based on deep learning method. METHODS WBUS images with probe position information were collected from 117 women. For each case, an automatic breast region segmentation by DeepResUnet was conducted, then fibroglandular tissues were extracted from breast region using fuzzy c-mean (FCM) classifier. Finally, the percentage of breast density and breast area of the DeepResUnet predicted region and the breast region of the ground truth were calculated and compared. RESULTS The average and standard deviation of each breast case for DeepResUnet predicted breast region of 10-fold in Accuracy (ACC) was 0.963±0.054. Sensitivity (SENS) was 0.928±0.11. Specificity (SPEC) was 0.967±0.054. Dice coefficient (Dice) was 0.916±0.98. Region intersection over union (IoU) was 0.856±0.134. Significant and very high correlations of breast density, fibroglandular tissue area and breast area (R = 0.843, R= 0.822 and R = 0.984, all p values < 0.001) were found between the ground truth and the result of the proposed method for ultrasound images. CONCLUSIONS Breast density, fibroglandular tissue, and breast volume evaluated based on the proposed method and WBUS system have significant correlations with ground truth, indicating that the proposed method and WBUS system has the potential to be an alternative modality for breast screening and density estimation in clinical use.
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Affiliation(s)
- Jie-Fan Chang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Ruey-Feng Chang
- Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, and MOST Joint Research Center for AI Technology and All Vista Healthcare, Taipei 10617, Taiwan.
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4
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Oceguera-Basurto P, Topete A, Oceguera-Villanueva A, Rivas-Carrillo J, Paz-Davalos M, Quintero-Ramos A, Del Toro-Arreola A, Daneri-Navarro A. Selective estrogen receptor modulators in the prevention of breast cancer in premenopausal women: a review. Transl Cancer Res 2020; 9:4444-4456. [PMID: 35117809 PMCID: PMC8797886 DOI: 10.21037/tcr-19-1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
The detection of premenopausal women at high risk of breast cancer is key to chemoprevention. Therapy with selective estrogen receptor modulators (SERMs) induces a significant antiproliferative effect in estrogen receptor (ER) positive breast cancer. This review was designed according the guidelines of the 2009 PRISMA statement. Searching different databases, including PubMed, MedlinePlus, PLoS One, Cochrane Breast Cancer Specialized Register, Clinical Trials.gov and American Society of Clinical Oncology. From 168 records screened, 15 full text articles were assessed for eligibility and only 7 studies met the inclusion criteria. Three of the studies included analyzed changes in Ki-67 expression, revealing weaker expression after treatment with acolbifene and raloxifene (P<0.001). Three studies also analyzed the breast volume by magnetic resonance imagining (MRI) and demonstrate a significant difference after 1 year with raloxifene treatment (P=0.0017). Moreover, a 20% reduction in breast density was observed after a 2-year treatment with tamoxifen in premenopausal women. SERMs reduce the risk of developing breast cancer. The studies reviewed here demonstrate the modulation of Ki-67 expression and changes in breast density, suggesting an important preventive role for this group of drugs in prevention for premenopausal women at high risk of developing breast cancer.
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Affiliation(s)
- Paola Oceguera-Basurto
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Antonio Topete
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Jorge Rivas-Carrillo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Antonio Quintero-Ramos
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Alicia Del Toro-Arreola
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Adrián Daneri-Navarro
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
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5
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Tossas-Milligan K, Shalabi S, Jones V, Keely PJ, Conklin MW, Elicerie KW, Winn R, Sistrunk C, Geradts J, Miranda-Carboni G, Dietze EC, Yee LD, Seewaldt VL. Mammographic density: intersection of advocacy, science, and clinical practice. CURRENT BREAST CANCER REPORTS 2019; 11:100-110. [PMID: 33312342 PMCID: PMC7728377 DOI: 10.1007/s12609-019-00316-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose Here we aim to review the association between mammographic density, collagen structure and breast cancer risk. Findings While mammographic density is a strong predictor of breast cancer risk in populations, studies by Boyd show that mammographic density does not predict breast cancer risk in individuals. Mammographic density is affected by age, parity, menopausal status, race/ethnicity, and body mass index (BMI).New studies normalize mammographic density to BMI may provide a more accurate way to compare mammographic density in women of diverse race and ethnicity. Preclinical and tissue-based studies have investigated the role collagen composition and structure in predicting breast cancer risk. There is emerging evidence that collagen structure may activate signaling pathways associated with aggressive breast cancer biology. Summary Measurement of film mammographic density does not adequately capture the complex signaling that occurs in women with at-risk collagen. New ways to measure at-risk collagen potentially can provide a more accurate view of risk.
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Affiliation(s)
| | - Sundus Shalabi
- City of Hope Comprehensive Cancer Center, Duarte, CA
- Al Quds University, Jerusalem, West Bank
| | | | | | | | | | - Robert Winn
- University of Illinois, Chicago Cancer Center, Chicago, IL
| | | | | | | | | | - Lisa D. Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA
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Kanbayti IH, Rae WID, McEntee MF, Ekpo EU. Are mammographic density phenotypes associated with breast cancer treatment response and clinical outcomes? A systematic review and meta-analysis. Breast 2019; 47:62-76. [PMID: 31352313 DOI: 10.1016/j.breast.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Mammographic density (MD) increases breast cancer (BC) risk, however, its association with patient outcomes is unclear. We examined the association of baseline MD (BMD), and MD reduction (MDR) following BC treatment with patient outcomes. Six databases (CINAHL, Scopus, PubMed, Web of Science, MEDLINE, and Embase) were used to identify relevant articles. The PRISMA strategy was used to extract relevant details. Study quality and risk of bias were assessed using the "Quality In Prognosis Studies" (QUIPS) tool. A Meta-analysis and pooled risk estimates were performed. Results showed that BMD is associated with contralateral breast cancer (CBC) risk (HR = 1.9; 95%CI: 1.3-3.0, p = 0.0007), recurrence (HR = 2.0; 95%CI: 1.0-4.0, p = 0.04), and mortality (HR = 1.4; 95%CI: 1.1-1.9, p = 0.003). No association was found between BMD and prognosis (HR = 3.2; 95%CI: 0.9-11.2, p = 0.06). Data on risk estimates (95%CI) from BMD for survival [RR: 1.75; 0.99-3.1 to 2.4; 1.4-4.1], ipsilateral BC [HR: 1; 0.6-1.6 to 3; 1.2-7.5], and treatment response (OR, 1.8; 0.98-3.3) are limited. MDR showed no association with mortality (HR = 0.5; 95%CI: 0.2-1.2, p = 0.13). MDR is associated with a reduced risk of recurrence [HR/RR: 0.35; 0.17-0.68 to 1.33; 0.67-2.65)], however data on MDR and outcomes such as mortality [HR/RR: 0.5; 0.27-0.93 to 0.59; 0.22-0.88], and CBC risk [RR/HR: 0.53; 0.24-0.84 to 1.3; 0.6-2.7] are limited. Evidence, although sparse, demonstrates that high BMD is associated with an increased risk of recurrence, CBC, and mortality. Conversely, MDR is associated with a reduced risk of BC recurrence, CBC, and BC-related mortality.
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Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Saudi Arabia; Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia.
| | - William I D Rae
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia; Department of Medicine Roinn na Sláinte, UG 12 Áras Watson, Brookfield Health Sciences, T12 AK54, Ireland
| | - Ernest U Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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Heller SL, Young Lin LL, Melsaether AN, Moy L, Gao Y. Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics 2018; 38:983-996. [DOI: 10.1148/rg.2018180035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Leng Leng Young Lin
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Amy N. Melsaether
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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8
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Shawky MS, Martin H, Hugo HJ, Lloyd T, Britt KL, Redfern A, Thompson EW. Mammographic density: a potential monitoring biomarker for adjuvant and preventative breast cancer endocrine therapies. Oncotarget 2018; 8:5578-5591. [PMID: 27894075 PMCID: PMC5354931 DOI: 10.18632/oncotarget.13484] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 11/25/2022] Open
Abstract
Increased mammographic density (MD) has been shown beyond doubt to be a marker for increased breast cancer risk, though the underpinning pathobiology is yet to be fully elucidated. Estrogenic activity exerts a strong influence over MD, which consequently has been observed to change predictably in response to tamoxifen anti-estrogen therapy, although results for other selective estrogen receptor modulators and aromatase inhibitors are less consistent. In both primary and secondary prevention settings, tamoxifen-associated MD changes correlate with successful modulation of risk or outcome, particularly among pre-menopausal women; an observation that supports the potential use of MD change as a surrogate marker where short-term MD changes reflect longer-term anti-estrogen efficacy. Here we summarize endocrine therapy-induced MD changes and attendant outcomes and discuss both the need for outcome surrogates in such therapy, as well as make a case for MD as such a monitoring marker. We then discuss the process and steps required to validate and introduce MD into practice as a predictor or surrogate for endocrine therapy efficacy in preventive and adjuvant breast cancer treatment settings.
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Affiliation(s)
- Michael S Shawky
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Egypt.,Department of Surgery, University College Hospital, London, UK
| | - Hilary Martin
- School of Medicine and Pharmacology, University of Western Australia, and Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Honor J Hugo
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Australia.,Translational Research Institute, Brisbane, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Kara L Britt
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| | - Andrew Redfern
- School of Medicine and Pharmacology, University of Western Australia, and Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Erik W Thompson
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia
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Moon WK, Chang JF, Lo CM, Chang JM, Lee SH, Shin SU, Huang CS, Chang RF. Quantitative breast density analysis using tomosynthesis and comparison with MRI and digital mammography. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 154:99-107. [PMID: 29249352 DOI: 10.1016/j.cmpb.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 09/06/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Breast density at mammography has been used as markers of breast cancer risk. However, newly introduced tomosynthesis and computer-aided quantitative method could provide more reliable breast density evaluation. METHODS In the experiment, 98 tomosynthesis image volumes were obtained from 98 women. For each case, an automatic skin removal was used and followed by a fuzzy c-mean (FCM) classifier which separated the fibroglandular tissues from other tissues in breast area. Finally, percent of breast density and breast volume were calculated and the results were compared with MRI. In addition, the percent of breast density and breast area of digital mammography calculated using the software Cumulus (University of Toronto, Toronto, ON, Canada.) were also compared with 3-D modalities. RESULTS Percent of breast density and breast volume, which were computed from tomosynthesis, MRI and digital mammography were 17.37% ± 4.39% and 607.12 cm3 ± 323.01 cm3, 20.3% ± 8.6% and 537.59 cm3 ± 287.74 cm3, and 12.03% ± 4.08%, respectively. There were significant correlations on breast density as well as volume between tomosynthesis and MRI (R = 0.482 and R = 0.805), tomosynthesis and breast density with breast area of digital mammography (R = 0.789 and R = 0.877), and MRI and breast density with breast area of digital mammography (R = 0.482 and R = 0.857) (all P values < .001). CONCLUSIONS Breast density and breast volume evaluated from tomosynthesis, MRI and breast density and breast area of digital mammographic images have significant correlations and indicate that tomosynthesis could provide useful 3-D information on breast density through proposed method.
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Affiliation(s)
- Woo Kyung Moon
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 110-744, Korea
| | - Jie-Fan Chang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Chung-Ming Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 110-744, Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 110-744, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 110-744, Korea
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Ruey-Feng Chang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 10617, Taiwan.
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O'Flynn EA, Fromageau J, Ledger AE, Messa A, D'Aquino A, Schoemaker MJ, Schmidt M, Duric N, Swerdlow AJ, Bamber JC. Ultrasound Tomography Evaluation of Breast Density: A Comparison With Noncontrast Magnetic Resonance Imaging. Invest Radiol 2017; 52:343-348. [PMID: 28121639 PMCID: PMC5417582 DOI: 10.1097/rli.0000000000000347] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Ultrasound tomography (UST) is an emerging whole-breast 3-dimensional imaging technique that obtains quantitative tomograms of speed of sound of the entire breast. The imaged parameter is the speed of sound which is used as a surrogate measure of density at each voxel and holds promise as a method to evaluate breast density without ionizing radiation. This study evaluated the technique of UST and compared whole-breast volume averaged speed of sound (VASS) with MR percent water content from noncontrast magnetic resonance imaging (MRI). MATERIALS AND METHODS Forty-three healthy female volunteers (median age, 40 years; range, 29-59 years) underwent bilateral breast UST and MRI using a 2-point Dixon technique. Reproducibility of VASS was evaluated using Bland-Altman analysis. Volume averaged speed of sound and MR percent water were evaluated and compared using Pearson correlation coefficient. RESULTS The mean ± standard deviation VASS measurement was 1463 ± 29 m s (range, 1434-1542 m s). There was high similarity between right (1464 ± 30 m s) and left (1462 ± 28 m s) breasts (P = 0.113) (intraclass correlation coefficient, 0.98). Mean MR percent water content was 35.7% ± 14.7% (range, 13.2%-75.3%), with small but significant differences between right and left breasts (36.3% ± 14.9% and 35.1% ± 14.7%, respectively; P = 0.004). There was a very strong correlation between VASS and MR percent water density (r = 0.96, P < 0.0001). CONCLUSIONS Ultrasound tomography holds promise as a reliable and reproducible 3-dimensional technique to provide a surrogate measure of breast density and correlates strongly with MR percent water content.
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Affiliation(s)
- Elizabeth A.M. O'Flynn
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Jeremie Fromageau
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Araminta E. Ledger
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Alessandro Messa
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Ashley D'Aquino
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Minouk J. Schoemaker
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Maria Schmidt
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Neb Duric
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Anthony J. Swerdlow
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Jeffrey C. Bamber
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
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Provinciali N, Suen C, Dunn BK, DeCensi A. Raloxifene hydrochloride for breast cancer risk reduction in postmenopausal women. Expert Rev Clin Pharmacol 2016; 9:1263-1272. [DOI: 10.1080/17512433.2016.1231575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Ekpo EU, Brennan PC, Mello-Thoms C, McEntee MF. Relationship Between Breast Density and Selective Estrogen-Receptor Modulators, Aromatase Inhibitors, Physical Activity, and Diet: A Systematic Review. Integr Cancer Ther 2016; 15:127-44. [PMID: 27130722 DOI: 10.1177/1534735416628343] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/10/2015] [Indexed: 12/16/2022] Open
Abstract
Background Lower breast density (BD) is associated with lower risk of breast cancer and may serve as a biomarker for the efficacy of chemopreventive strategies. This review explores parameters that are thought to be associated with lower BD. We conducted a systematic review of articles published to date using the PRISMA strategy. Articles that assessed change in BD with estrogen-receptor modulators (tamoxifene [TAM], raloxifene [RLX], and tibolone) and aromatase inhibitors (AIs), as well as cross-sectional and longitudinal studies (LSs) that assessed association between BD and physical activity (PA) or diet were reviewed. Results Ten studies assessed change in BD with TAM; all reported TAM-mediated BD decreases. Change in BD with RLX was assessed by 11 studies; 3 reported a reduction in BD. Effect of tibolone was assessed by 5 RCTs; only 1 reported change in BD. AI-mediated BD reduction was reported by 3 out of 10 studies. The association between PA and BD was assessed by 21 studies; 4 reported an inverse association. The relationship between diet and BD was assessed in 34 studies. All studies on calcium and vitamin D as well as vegetable intake reported an inverse association with BD in premenopausal women. Two RCTs demonstrated BD reduction with a low-fat, high-carbohydrate intervention. Conclusion TAM induces BD reduction; however, the effect of RLX, tibolone, and AIs on BD is unclear. Although data on association between diet and BD in adulthood are contradictory, intake of vegetables, vitamin D, and calcium appear to be associated with lower BD in premenopausal women.
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Affiliation(s)
- Ernest U Ekpo
- University of Sydney, NSW, Australia University of Calabar, Nigeria
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Ledger AEW, Scurr ED, Hughes J, Macdonald A, Wallace T, Thomas K, Wilson R, Leach MO, Schmidt MA. Comparison of Dixon Sequences for Estimation of Percent Breast Fibroglandular Tissue. PLoS One 2016; 11:e0152152. [PMID: 27011312 PMCID: PMC4806997 DOI: 10.1371/journal.pone.0152152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/09/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate sources of error in the Magnetic Resonance Imaging (MRI) measurement of percent fibroglandular tissue (%FGT) using two-point Dixon sequences for fat-water separation. METHODS Ten female volunteers (median age: 31 yrs, range: 23-50 yrs) gave informed consent following Research Ethics Committee approval. Each volunteer was scanned twice following repositioning to enable an estimation of measurement repeatability from high-resolution gradient-echo (GRE) proton-density (PD)-weighted Dixon sequences. Differences in measures of %FGT attributable to resolution, T1 weighting and sequence type were assessed by comparison of this Dixon sequence with low-resolution GRE PD-weighted Dixon data, and against gradient-echo (GRE) or spin-echo (SE) based T1-weighted Dixon datasets, respectively. RESULTS %FGT measurement from high-resolution PD-weighted Dixon sequences had a coefficient of repeatability of ±4.3%. There was no significant difference in %FGT between high-resolution and low-resolution PD-weighted data. Values of %FGT from GRE and SE T1-weighted data were strongly correlated with that derived from PD-weighted data (r = 0.995 and 0.96, respectively). However, both sequences exhibited higher mean %FGT by 2.9% (p < 0.0001) and 12.6% (p < 0.0001), respectively, in comparison with PD-weighted data; the increase in %FGT from the SE T1-weighted sequence was significantly larger at lower breast densities. CONCLUSION Although measurement of %FGT at low resolution is feasible, T1 weighting and sequence type impact on the accuracy of Dixon-based %FGT measurements; Dixon MRI protocols for %FGT measurement should be carefully considered, particularly for longitudinal or multi-centre studies.
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Affiliation(s)
- Araminta E. W. Ledger
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Erica D. Scurr
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Julie Hughes
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Macdonald
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Toni Wallace
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Karen Thomas
- Clinical Research and Development, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin Wilson
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O. Leach
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Maria A. Schmidt
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
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Chen JH, Chan S, Tang YT, Hon JS, Tseng PC, Cheriyan AT, Shah NR, Yeh DC, Lee SK, Chen WP, McLaren CE, Su MY. Impact of positional difference on the measurement of breast density using MRI. Med Phys 2016; 42:2268-75. [PMID: 25979021 DOI: 10.1118/1.4917083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study investigated the impact of arms/hands and body position on the measurement of breast density using MRI. METHODS Noncontrast-enhanced T1-weighted images were acquired from 32 healthy women. Each subject received four MR scans using different experimental settings, including a high resolution hands-up, a low resolution hands-up, a high resolution hands-down, and finally, another high resolution hands-up after repositioning. The breast segmentation was performed using a fully automatic chest template-based method. The breast volume (BV), fibroglandular tissue volume (FV), and percent density (PD) measured from the four MR scan settings were analyzed. RESULTS A high correlation of BV, FV, and PD between any pair of the four MR scans was noted (r > 0.98 for all). Using the generalized estimating equation method, a statistically significant difference in mean BV among four settings was noted (left breast, score test p = 0.0056; right breast, score test p = 0.0016), adjusted for age and body mass index. Despite differences in BV, there were no statistically significant differences in the mean PDs among the four settings (p > 0.10 for left and right breasts). Using Bland-Altman plots, the smallest mean difference/bias and standard deviations for BV, FV, and PD were noted when comparing hands-up high vs low resolution when the breast positions were exactly the same. CONCLUSIONS The authors' study showed that BV, FV, and PD measurements from MRI of different positions were highly correlated. BV may vary with positions but the measured PD did not differ significantly between positions. The study suggested that the percent density analyzed from MRI studies acquired using different arms/hands and body positions from multiple centers can be combined for analysis.
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Affiliation(s)
- Jeon-Hor Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020 and Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Siwa Chan
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yi-Ting Tang
- Department of Radiological Technology, China Medical University, Taichung 40402, Taiwan
| | - Jia Shen Hon
- Department of Radiological Technology, China Medical University, Taichung 40402, Taiwan
| | - Po-Chuan Tseng
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| | - Angela T Cheriyan
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| | - Nikita Rakesh Shah
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| | - Dah-Cherng Yeh
- Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - San-Kan Lee
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Wen-Pin Chen
- Department of Epidemiology, University of California, Irvine, California 92697-5020
| | - Christine E McLaren
- Department of Epidemiology, University of California, Irvine, California 92697-5020
| | - Min-Ying Su
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
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Imaging Breast Density: Established and Emerging Modalities. Transl Oncol 2015; 8:435-45. [PMID: 26692524 PMCID: PMC4700291 DOI: 10.1016/j.tranon.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022] Open
Abstract
Mammographic density has been proven as an independent risk factor for breast cancer. Women with dense breast tissue visible on a mammogram have a much higher cancer risk than women with little density. A great research effort has been devoted to incorporate breast density into risk prediction models to better estimate each individual’s cancer risk. In recent years, the passage of breast density notification legislation in many states in USA requires that every mammography report should provide information regarding the patient’s breast density. Accurate definition and measurement of breast density are thus important, which may allow all the potential clinical applications of breast density to be implemented. Because the two-dimensional mammography-based measurement is subject to tissue overlapping and thus not able to provide volumetric information, there is an urgent need to develop reliable quantitative measurements of breast density. Various new imaging technologies are being developed. Among these new modalities, volumetric mammographic density methods and three-dimensional magnetic resonance imaging are the most well studied. Besides, emerging modalities, including different x-ray–based, optical imaging, and ultrasound-based methods, have also been investigated. All these modalities may either overcome some fundamental problems related to mammographic density or provide additional density and/or compositional information. The present review article aimed to summarize the current established and emerging imaging techniques for the measurement of breast density and the evidence of the clinical use of these density methods from the literature.
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Wu AH, Spicer D, Garcia A, Tseng CC, Hovanessian-Larsen L, Sheth P, Martin SE, Hawes D, Russell C, MacDonald H, Tripathy D, Su MY, Ursin G, Pike MC. Double-Blind Randomized 12-Month Soy Intervention Had No Effects on Breast MRI Fibroglandular Tissue Density or Mammographic Density. Cancer Prev Res (Phila) 2015; 8:942-51. [PMID: 26276750 PMCID: PMC4596769 DOI: 10.1158/1940-6207.capr-15-0125] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/10/2015] [Indexed: 02/06/2023]
Abstract
Soy supplementation by patients with breast cancer remains controversial. No controlled intervention studies have investigated the effects of soy supplementation on mammographic density in patients with breast cancer. We conducted a double-blind, randomized, placebo-controlled intervention study in previously treated patients with breast cancer (n = 66) and high-risk women (n = 29). We obtained digital mammograms and breast MRI scans at baseline and after 12 months of daily soy (50 mg isoflavones per day; n = 46) or placebo (n = 49) tablet supplementation. The total breast area (MA) and the area of mammographic density (MD) on the mammogram were measured using a validated computer-assisted method, and mammographic density percent (MD% = 100 × MD/MA) was determined. A well-tested computer algorithm was used to quantitatively measure the total breast volume (TBV) and fibroglandular tissue volume (FGV) on the breast MRI, and the FGV percent (FGV% = 100 × FGV/TBV) was calculated. On the basis of plasma soy isoflavone levels, compliance was excellent. Small decreases in MD% measured by the ratios of month 12 to baseline levels were seen in the soy (0.95) and the placebo (0.87) groups; these changes did not differ between the treatments (P = 0.38). Small decreases in FGV% were also found in both the soy (0.90) and the placebo (0.92) groups; these changes also did not differ between the treatments (P = 0.48). Results were comparable in patients with breast cancer and high-risk women. We found no evidence that soy supplementation would decrease mammographic density and that MRI might be more sensitive to changes in density than mammography.
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MESH Headings
- Adult
- Aged
- Breast Density
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Dietary Supplements
- Double-Blind Method
- Female
- Humans
- Magnetic Resonance Imaging
- Mammary Glands, Human/abnormalities
- Mammary Glands, Human/drug effects
- Middle Aged
- Radiography
- Soybean Proteins/therapeutic use
- Glycine max
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Affiliation(s)
- Anna H Wu
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.
| | - Darcy Spicer
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Agustin Garcia
- Hematology Oncology, Louisiana State University, New Orleans, Louisiana
| | - Chiu-Chen Tseng
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Linda Hovanessian-Larsen
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Pulin Sheth
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Sue Ellen Martin
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Debra Hawes
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Christy Russell
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Heather MacDonald
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Debu Tripathy
- MBreast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Min-Ying Su
- Tu and Yuen Center for Functional Onco-Imaging, University of California, Irvine, Irvine, California
| | - Giske Ursin
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California. Department of Nutrition, University of Oslo, Oslo, Norway. Cancer Registry of Norway, Oslo, Oslo, Norway
| | - Malcolm C Pike
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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Albert M, Schnabel F, Chun J, Schwartz S, Lee J, Klautau Leite AP, Moy L. The relationship of breast density in mammography and magnetic resonance imaging in high-risk women and women with breast cancer. Clin Imaging 2015; 39:987-92. [PMID: 26351036 DOI: 10.1016/j.clinimag.2015.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the relationship between mammographic breast density (MBD), background parenchymal enhancement (BPE), and fibroglandular tissue (FGT) in women with breast cancer (BC) and at high risk for developing BC. METHODS Our institutional database was queried for patients who underwent mammography and MRI. RESULTS Four hundred three (85%) had BC and 72 (15%) were at high risk. MBD (P=.0005), BPE (P<.0001), and FGT (P=.02) were all higher in high-risk women compared to the BC group. CONCLUSIONS Higher levels of MBD, BPE and FGT are seen in women at higher risk for developing BC when compared to women with BC.
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Affiliation(s)
- Marissa Albert
- Department of Radiology, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Freya Schnabel
- Department of Surgery, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Jennifer Chun
- Department of Surgery, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Shira Schwartz
- Department of Surgery, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Jiyon Lee
- Department of Radiology, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
| | - Ana Paula Klautau Leite
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil 05024-000 SP
| | - Linda Moy
- Department of Radiology, New York University Langone Medical Center, Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA.
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Abstract
OBJECTIVE. The purpose of this article is to review the use of MRI in breast density measurement and breast cancer risk estimation and to discuss the role of MRI as an alternative screening to mammography for screening women with dense breasts. CONCLUSION. The potential of MRI for screening women with dense breasts remains controversial because of the paucity of clinical evidence, the possibility of overdiagnosis, and the cost-effectiveness of the technique in this population. Although methods of MRI measurement require standardization and automation, future addition of MRI density to risk models may positively impact their value.
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Affiliation(s)
- Elizabeth A M O'Flynn
- 1 All authors: Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
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Inter- and Intrareader Agreement for Categorization of Background Parenchymal Enhancement at Baseline and After Training. AJR Am J Roentgenol 2014; 203:209-15. [DOI: 10.2214/ajr.13.10952] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Breast density assessment using a 3T MRI system: comparison among different sequences. PLoS One 2014; 9:e99027. [PMID: 24892933 PMCID: PMC4044003 DOI: 10.1371/journal.pone.0099027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/09/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare MRI sequences for breast density measurements on a 3T MRI system using IDEAL (Iterative Decomposition of water and fat with Echo Asymmetry and Least squares estimation) as possible physiology-like reference. Materials and Methods MRI examination was performed in 48 consecutive patients (mean age 41, years; range, 35–67 years) on a 3.0T scanner and 46 were included. All (fertile) women, were examined between days 5 and 15 of their menstrual cycle. MRI protocol included: T1-turbo spin-echo (T1-tSE), T2-turbo spin-echo (T2-tSE), VIBRANT (Volume Imaging for Breast Assessment) before and after injection of contrast media and IDEAL. Breast density was calculated with semi-automated software. Statistical analysis was performed with non-parametric tests. Results Mean percentage of breast density calculated in each sequence was: T1-tSE = 56%; T2-tSE = 52%; IDEAL FatOnly = 55%; IDEAL WaterOnly = 53%, VIBRANT = 55%. Significant differences were observed between T2-tSE and both T1-tSE (p<0.001), VIBRANT sequences (p = 0.009), T1-tSE and both IDEAL WaterOnly (p = 0.007) and IDEAL FatOnly (p = 0.047). Breast density percentage showed a positive linear correlation among different sequences: r≥0.93. Conclusions Differences exist between MRI sequences used to assess breast density percentage. T1-weighted sequences values were similar to IDEAL sequences.
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Palestrant S, Comstock CE, Moy L. Approach to Breast Magnetic Resonance Imaging Interpretation. Radiol Clin North Am 2014; 52:563-83. [DOI: 10.1016/j.rcl.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Effect of preventive hormonal therapy on breast density: a systematic qualitative review. ScientificWorldJournal 2014; 2014:942386. [PMID: 24895676 PMCID: PMC4032660 DOI: 10.1155/2014/942386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/20/2013] [Indexed: 11/25/2022] Open
Abstract
Breast density (BD) is recognized as one of the strongest independent risk factors of breast cancer (BC). Unlike most other risk factors, BD can be modified, suggesting that it may be a biomarker for preventive interventions. We conducted a qualitative systematic review to address the effect of preventive hormonal therapy on BD. Among the 26 relevant studies, 10 assessed the effect of tamoxifen on BD (TAM: n = 2 877), 9 that of raloxifene (RLX: n = 1 544), and 7 that of aromatase inhibitors (AI: n = 416). The studies were characterized by a large heterogeneity in designs and in methods of BD measurement. BD could be reduced by TAM (10 studies/10). However, the effect of RLX and AI on BD remains unclear due to conflicting results between studies. Consequently, it is crucial to develop practical, accurate, and reproducible methods of measurement in order to be able to compare the effect of preventive hormonal agents on BD and to determine whether change in BD can be used as a predictor of response to therapy.
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Chen JH, Pan WF, Kao J, Lu J, Chen LK, Kuo CC, Chang CK, Chen WP, McLaren CE, Bahri S, Mehta RS, Su MY. Effect of taxane-based neoadjuvant chemotherapy on fibroglandular tissue volume and percent breast density in the contralateral normal breast evaluated by 3T MR. NMR IN BIOMEDICINE 2013; 26:1705-13. [PMID: 23940080 PMCID: PMC3838444 DOI: 10.1002/nbm.3006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 05/23/2023]
Abstract
The aim of this study was to evaluate the change of breast density in the normal breast of patients receiving neoadjuvant chemotherapy (NAC). Forty-four breast cancer patients were studied. MRI acquisition was performed before treatment (baseline), and 4 and 12 weeks after treatment. A computer-algorithm-based program was used to segment breast tissue and calculate breast volume (BV), fibroglandular tissue volume (FV), and percent density (PD) (the ratio of FV over BV × 100%). The reduction of FV and PD after treatment was compared with baseline using paired t-tests with a Bonferroni-Holm correction. The association of density reduction with age was analyzed. FV and PD after NAC showed significant decreases compared with the baseline. FV was 110.0 ml (67.2, 189.8) (geometric mean (interquartile range)) at baseline, 104.3 ml (66.6, 164.4) after 4 weeks (p < 0.0001), and 94.7 ml (60.2, 144.4) after 12 weeks (comparison with baseline, p < 0.0001; comparison with 4 weeks, p = 0.016). PD was 11.2% (6.4, 22.4) at baseline, 10.6% (6.6, 20.3) after 4 weeks (p < 0.0001), and 9.7% (6.2, 17.9) after 12 weeks (comparison with baseline, p = 0.0001; comparison with 4 weeks, p = 0.018). Younger patients tended to show a higher density reduction, but overall correlation with age was only moderate (r = 0.28 for FV, p = 0.07, and r = 0.52 for PD, p = 0.0003). Our study showed that breast density measured from MR images acquired at 3T MR can be accurately quantified using a robust computer-aided algorithm based on non-parametric non-uniformity normalization (N3) and an adaptive fuzzy C-means algorithm. Similar to doxorubicin and cyclophosphamide regimens, the taxane-based NAC regimen also caused density atrophy in the normal breast and showed reduction in FV and PD. The effect of breast density reduction was age related and duration related.
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Affiliation(s)
- Jeon-Hor Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Wei-Fan Pan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Julian Kao
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Jocelyn Lu
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Li-Kuang Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Chih-Chen Kuo
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Kai Chang
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Pin Chen
- Department of Epidemiology, University of California Irvine, California, USA
| | | | - Shadfar Bahri
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Rita S. Mehta
- Department of Medicine, University of California Irvine, California
| | - Min-Ying Su
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
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Biomarker Endpoints for Early-Phase Cancer-Prevention Studies. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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The impact of bilateral salpingo-oophorectomy on breast MRI background parenchymal enhancement and fibroglandular tissue. Eur Radiol 2013; 24:162-8. [PMID: 23982290 DOI: 10.1007/s00330-013-2993-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of bilateral salpingo-oophorectomy (BSO) on background parenchymal enhancement (BPE) and the amount of fibroglandular tissue (FGT) seen on breast MRI. METHODS Retrospective review identified 21 BRCA mutation carriers who underwent breast MRI before and after elective BSO. After exclusion of patients placed on postoperative hormone replacement therapy, there were 18 eligible patients. Blinded to surgical status, three independent readers used categorical scales to rate BPE (minimal, mild, moderate, marked) and the amount of FGT (fatty, scattered, heterogeneously dense, dense) on pre- and post-BSO MRI examinations. The sign test was used to assess for changes in the categorical ratings of BPE and FGT. RESULTS Significant proportions of women demonstrated decreases in BPE and in the amount of FGT following oophorectomy (P = 0.004 and 0.02, respectively.) BPE decreases were larger and seen earlier than FGT changes. There was no significant relationship between age/body mass index and changes in BPE and FGT. CONCLUSIONS BPE and the amount of FGT seen on breast MRI are significantly decreased by oophorectomy; BPE decreases to a greater extent and earlier than FGT. KEY POINTS • Background parenchymal enhancement significantly decreases at breast MRI following oophorectomy. • Fibroglandular tissue significantly decreases on breast MRI following oophorectomy. • Decrease in background parenchymal enhancement is greater than in fibroglandular tissue. • Decrease in background parenchymal enhancement occurs earlier than in fibroglandular tissue.
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Vachon CM, Ghosh K, Brandt KR. Mammographic Density: Potential as a Risk Factor and Surrogate Marker in the Clinical Setting. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0118-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen JH, Chen WP, Chan S, Yeh DC, Su MY, McLaren CE. Correlation of endogenous hormonal levels, fibroglandular tissue volume and percent density measured using 3D MRI during one menstrual cycle. Ann Oncol 2013; 24:2329-35. [PMID: 23661294 DOI: 10.1093/annonc/mdt158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We measured breast density (BD) on MRI and correlated with endogenous hormonal levels. PATIENTS AND METHODS Twenty-four premenopausal women received four weekly breast MRI. A blood sample was collected on the same day of MRI. BD was measured using a computer-based algorithm. The generalized estimation equation method was applied to model mean fibroglandular tissue volume (FV) and mean percent density (PD) from predictor variables including estradiol, progesterone, and week during a cycle. RESULTS In week 3, a borderline significant correlation between estradiol and PD (r = 0.43, P = 0.04), estradiol and FV (r = 0.40, P = 0.05) and between progesterone and FV (r = 0.42, P = 0.04) was noted. The FV and PD measured in weeks 4 and 1 were higher than in weeks 2 and 3, adjusted for variation in endogenous estradiol and progesterone, indicating that the hormone change could not account for the changes in density. No lag effect of endogenous hormone on the change of FV or PD was noted (all P-values > 0.05). CONCLUSIONS Our results showed that BD is not strongly associated with the endogenous hormone. Their association with breast cancer risk was likely coming from different mechanisms, and they should be considered as independent risk factors.
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Affiliation(s)
- J H Chen
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, Irvine, USA.
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Abstract
Prevention of cancer remains the most promising strategy for reducing both its incidence and the mortality due to this disease. For more than four decades, findings from epidemiology, basic research and clinical trials have informed the development of lifestyle and medical approaches to cancer prevention. These include selective oestrogen receptor modulators and aromatase inhibitors for breast cancer, the 5-α-reductase inhibitors finasteride and dutasteride for prostate cancer, and the development of vaccines for viruses that are associated with specific cancers. Future directions include genetic, proteomic and other molecular approaches for identifying pathways that are associated with cancer initiation and development, as well as refining the search for immunologically modifiable causes of cancer.
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Affiliation(s)
- Asad Umar
- National Cancer Institute, Division of Cancer Prevention, Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Executive Plaza North 2142, 6130 Executive Boulevard, MSC 7317, Rockville, Maryland 20852-7371, USA.
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Lu LJW, Nishino TK, Johnson RF, Nayeem F, Brunder DG, Ju H, Leonard MH, Grady JJ, Khamapirad T. Comparison of breast tissue measurements using magnetic resonance imaging, digital mammography and a mathematical algorithm. Phys Med Biol 2012; 57:6903-27. [PMID: 23044556 DOI: 10.1088/0031-9155/57/21/6903] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Women with mostly mammographically dense fibroglandular tissue (breast density, BD) have a four- to six-fold increased risk for breast cancer compared to women with little BD. BD is most frequently estimated from two-dimensional (2D) views of mammograms by a histogram segmentation approach (HSM) and more recently by a mathematical algorithm consisting of mammographic imaging parameters (MATH). Two non-invasive clinical magnetic resonance imaging (MRI) protocols: 3D gradient-echo (3DGRE) and short tau inversion recovery (STIR) were modified for 3D volumetric reconstruction of the breast for measuring fatty and fibroglandular tissue volumes by a Gaussian-distribution curve-fitting algorithm. Replicate breast exams (N = 2 to 7 replicates in six women) by 3DGRE and STIR were highly reproducible for all tissue-volume estimates (coefficients of variation <5%). Reliability studies compared measurements from four methods, 3DGRE, STIR, HSM, and MATH (N = 95 women) by linear regression and intra-class correlation (ICC) analyses. Rsqr, regression slopes, and ICC, respectively, were (1) 0.76-0.86, 0.8-1.1, and 0.87-0.92 for %-gland tissue, (2) 0.72-0.82, 0.64-0.96, and 0.77-0.91, for glandular volume, (3) 0.87-0.98, 0.94-1.07, and 0.89-0.99, for fat volume, and (4) 0.89-0.98, 0.94-1.00, and 0.89-0.98, for total breast volume. For all values estimated, the correlation was stronger for comparisons between the two MRI than between each MRI versus mammography, and between each MRI versus MATH data than between each MRI versus HSM data. All ICC values were >0.75 indicating that all four methods were reliable for measuring BD and that the mathematical algorithm and the two complimentary non-invasive MRI protocols could objectively and reliably estimate different types of breast tissues.
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Affiliation(s)
- Lee-Jane W Lu
- Department of Preventative Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX 77555-1109, USA
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Chen JH, Chan S, Liu YJ, Yeh DC, Chang CK, Chen LK, Pan WF, Kuo CC, Lin M, Chang DHE, Fwu PT, Su MY. Consistency of breast density measured from the same women in four different MR scanners. Med Phys 2012; 39:4886-95. [PMID: 22894415 DOI: 10.1118/1.4736824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To compare the breast volume (BV), fibroglandular tissue volume (FV), and percent density (PD) measured from breast MRI of the same women using four different MR scanners. METHODS The study was performed in 34 healthy Asian volunteers using two 1.5T (GE and Siemens) and two 3T (GE and Philips) MR scanners. The BV, FV, and PD were measured on nonfat-suppressed T1-weighted images using a comprehensive computer algorithm-based segmentation method. The scanner-to-scanner measurement difference, and the coefficient of variation (CV) among the four scanners were calculated. The measurement variation between two density morphological patterns presenting as the central type and the intermingled type was separately analyzed and compared. RESULTS All four scanners provided satisfactory image quality allowing for successful completion of the segmentation processes. The measured parameters between each pair of MR scanners were highly correlated, with R(2) ≥ 0.95 for BV, R(2) ≥ 0.99 for FV, and R(2) ≥ 0.97 for PD in all comparisons. The mean percent differences between each pair of scanners were 5.9%-7.8% for BV, 5.3%-6.5% for FV, 4.3%-7.3% for PD; with the overall CV of 5.8% for BV, 4.8% for FV, and 4.9% for PD. The variation of FV was smaller in the central type than in the intermingled type (p = 0.04). CONCLUSIONS The results showed that the variation of FV and PD measured from four different MR scanners is around 5%, suggesting the parameters measured using different scanners can be used for a combined analysis in a multicenter study.
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Affiliation(s)
- Jeon-Hor Chen
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Science, University of California Irvine, California 92697-5020, USA.
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King V, Kaplan J, Pike MC, Liberman L, David Dershaw D, Lee CH, Brooks JD, Morris EA. Impact of tamoxifen on amount of fibroglandular tissue, background parenchymal enhancement, and cysts on breast magnetic resonance imaging. Breast J 2012; 18:527-34. [PMID: 23002953 DOI: 10.1111/tbj.12002] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to evaluate the impact of tamoxifen treatment on amount of fibroglandular tissue (FGT), background parenchymal enhancement (BPE), and cysts on breast MRI. Retrospective search identified 96 women with breast cancer who had a breast MRI both before and during adjuvant tamoxifen therapy between 2002 and 2008. After exclusion of all irradiated breasts, 88 women were eligible. Two readers blinded to tamoxifen treatment status independently rated level of BPE, amount of FGT, and cysts using a 4-point categorical scale: BPE--Minimal, Mild, Moderate, Marked; FGT--Fatty, Scattered, Heterogeneously Dense (HD), Dense; Cysts--Minimal, Mild, Moderate, Marked. A consensus interpretation was reached in cases of disagreement. During tamoxifen, there was a significant shift from higher to lower degree BPE, cysts, and FGT compared with before tamoxifen. BPE, cysts and FGT decreased in 68% (60/88), 38% (33/88), and 40% (35/88) of women during tamoxifen (p<0.001 for all measures). After the exclusion of all cases with minimal BPE, cysts, or FGT on the pre-tamoxifen MRI, the percentage of women demonstrating a decrease in these factors increased to 81% (60/74), 77% (33/43), and 41% (35/86), respectively. Exclusion of patients treated with chemotherapy did not substantially change these results. The percentage of women with decreases in FGT and cysts increased with greater duration on tamoxifen, whereas decreases in BPE were detected early in treatment (<90 days) and did not change substantially with longer duration on tamoxifen. A significant association exists between treatment with tamoxifen and decreases in BPE, cysts, and FGT on breast MRI.
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Affiliation(s)
- Valencia King
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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King V, Goldfarb SB, Brooks JD, Sung JS, Nulsen BF, Jozefara JE, Pike MC, Dickler MN, Morris EA. Effect of Aromatase Inhibitors on Background Parenchymal Enhancement and Amount of Fibroglandular Tissue at Breast MR Imaging. Radiology 2012; 264:670-8. [DOI: 10.1148/radiol.12112669] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol 2012; 22:2641-7. [DOI: 10.1007/s00330-012-2553-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/25/2022]
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35
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Chang DHE, Chen JH, Lin M, Bahri S, Yu HJ, Mehta RS, Nie K, Hsiang DJB, Nalcioglu O, Su MY. Comparison of breast density measured on MR images acquired using fat-suppressed versus nonfat-suppressed sequences. Med Phys 2012; 38:5961-8. [PMID: 22047360 DOI: 10.1118/1.3646756] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the difference of MR percent breast density measured from fat-suppressed versus nonfat-suppressed imaging sequences. METHODS Breast magnetic resonance imaging (MRI) with and without fat suppression was acquired from 38 subjects. Breasts were divided into subgroups of different morphological patterns ("central" and "intermingled" types). Breast volume, fibroglandular tissue volume, and percent density were measured. The results were compared using nonparametric statistical tests and regarded as significant at p < 0.05. RESULTS Breast volume, fibroglandular volume, and percent density between fat-suppressed and nonfat-suppressed sequences were highly correlated. Breast volumes measured on these two sequences were almost identical. Fibroglandular tissue volume and percent density, however, had small (<5%) yet significant differences between the two sequences-they were both higher on the fat-suppressed sequence. Intraobserver variability was within 4% for both sequences and different morphological types. The fibroglandular tissue volume measured on downsampled images showed a small (<5%) yet significant difference. CONCLUSIONS The measurement of breast density made on MRI acquired using fat-suppressed and nonfat-suppressed T1W images was about 5% difference, only slightly higher than the intraobserver variability of 3%-4%. When the density data from multiple centers were to be combined, evaluating the degree of difference is needed to take this difference into account.
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Affiliation(s)
- Daniel H-E Chang
- Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
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Millet I, Pages E, Hoa D, Merigeaud S, Curros Doyon F, Prat X, Taourel P. Pearls and pitfalls in breast MRI. Br J Radiol 2011; 85:197-207. [PMID: 22128131 DOI: 10.1259/bjr/47213729] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.
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Affiliation(s)
- I Millet
- Department of Imaging, Lapeyronie Hospital, Montpellier, France
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Chen JH, Chan S, Chang DHE, Lin M, Su MY. Consistency of breast density measured from the same women using different MR scanners. Ann Oncol 2011; 22:2693-2694. [PMID: 22015449 DOI: 10.1093/annonc/mdr456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J-H Chen
- Department of Radiological Science, Tu & Yuen Center for Functional Onco-Imaging, University of California Irvine, USA; Department of Radiology, China Medical University Hospital, Taichung; Department of Medicine, College of Medicine, China Medical University, Taichung.
| | - S Chan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - D H-E Chang
- Department of Radiological Science, Tu & Yuen Center for Functional Onco-Imaging, University of California Irvine, USA
| | - M Lin
- Department of Radiological Science, Tu & Yuen Center for Functional Onco-Imaging, University of California Irvine, USA
| | - M-Y Su
- Department of Radiological Science, Tu & Yuen Center for Functional Onco-Imaging, University of California Irvine, USA
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Heckman-Stoddard BM, Foster KA, Dunn BK. Update on Phase I/II Breast Cancer Prevention Trials. CURRENT BREAST CANCER REPORTS 2011. [DOI: 10.1007/s12609-011-0048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chan S, Su MYL, Lei FJ, Wu JP, Lin M, Nalcioglu O, Feig SA, Chen JH. Menstrual cycle-related fluctuations in breast density measured by using three-dimensional MR imaging. Radiology 2011; 261:744-51. [PMID: 21878616 DOI: 10.1148/radiol.11110506] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the fluctuation of fibroglandular tissue volume (FV) and percentage of breast density (PD) during the menstrual cycle and compare with postmenopausal women by using three-dimensional magnetic resonance (MR)-based segmentation methods. MATERIALS AND METHODS This study was approved by the Institutional Review Board and was HIPAA compliant. Written informed consent was obtained. Thirty healthy female subjects, 24 premenopausal and six postmenopausal, were recruited. All subjects underwent MR imaging examination each week for 4 consecutive weeks. The breast volume (BV), FV, and PD were measured by two operators to evaluate interoperator variation. The fluctuation of each parameter measured over the course of the four examinations was evaluated on the basis of the coefficient of variation (CV). RESULTS The results from two operators showed a high Pearson correlation for BV (R(2) = 0.99), FV (R(2) = 0.98), and PD (R(2) = 0.96). The interoperator variation was 3% for BV and around 5%-6% for FV and PD. In the respective premenopausal and postmenopausal groups, the mean CV was 5.0% and 5.6% for BV, 7.6% and 4.2% for FV, and 7.1% and 6.0% for PD. The difference between premenopausal and postmenopausal groups was not significant (all P values > .05). CONCLUSION The fluctuation of breast density measured at MR imaging during a menstrual cycle was around 7%. The results may help the design and interpretation of future studies by using the change of breast density as a surrogate marker to evaluate the efficacy of hormone-modifying drugs for cancer treatment or cancer prevention.
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Affiliation(s)
- Siwa Chan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
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Moon WK, Shen YW, Huang CS, Luo SC, Kuzucan A, Chen JH, Chang RF. Comparative study of density analysis using automated whole breast ultrasound and MRI. Med Phys 2011; 38:382-9. [PMID: 21361206 DOI: 10.1118/1.3523617] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the measurements of breast density using three-dimensional (3-D) automated whole breast ultrasound (ABUS) and magnetic resonance imaging (MRI). METHODS In this study, 3-D ABUS and MRI breast images were obtained from 40 patients-bilaterally in 27 patients and unilaterally (due to operation in the contralateral breast) in 13 patients, To differentiate the fibroglandular and fatty tissues in ABUS and MRI images, the fuzzy C-mean classifier was used. Calculated values for percent density and breast volume from the two modalities were compared to and correlated with linear regression analysis. Intraoperator and interoperator variations among eight cases were evaluated to verify the consistency of the density analysis. RESULTS Mean percent density and breast volume derived from ABUS (17.63 +/- 11.87% and 418.30 +/- 132.97 cm3, respectively) and MRI images (23.79 +/- 16.62% and 544.90 +/- 207.41 cm3) demonstrated good correlation (R = 0.917 and R = 0.884). Intraoperator and interoperator analyses yielded slightly larger coefficients of variation for percent density and breast volume in ABUS compared to MRI. However, the differences were not statistically significant. CONCLUSIONS ABUS and MRI showed high correlation for breast density and breast volume quantification. Both modalities could provide useful breast density information to physicians.
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Affiliation(s)
- Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
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Dunn BK, Jegalian K, Greenwald P. Biomarkers for early detection and as surrogate endpoints in cancer prevention trials: issues and opportunities. Recent Results Cancer Res 2011; 188:21-47. [PMID: 21253787 DOI: 10.1007/978-3-642-10858-7_3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to improve the early detection and diagnosis of cancer, give more accurate prognoses, stratify individuals by risk, predict response to treatment, and help the transition of basic research into clinical application, biomarkers are needed that accurately represent or predict clinical outcomes. To be useful in trials for chemopreventive agent development, biomarkers must be subject to modulation, easy to obtain and quantify, and have biological meaning, ideally representing steps in well-understood carcinogenic pathways. Though difficult to validate fully, wisely chosen biomarkers in early-phase trials can inform the prioritization of large-scale, long-term trials that measure clinical outcomes. When well-designed, smaller trials using biomarkers as surrogate endpoints should promote faster decisions regarding which targeted preventive agents to pursue, promising greater progress in the personalization of medicine. Biomarkers could become useful in distinguishing indolent from aggressive forms of ductal carcinoma in situ as well as localized invasive breast and prostate cancer, lesions that are often overtreated. Chemopreventive strategies that reduce the progression of early forms of premalignancy can benefit patients not only by reducing their risk of cancer and death from cancer but also by reducing their need for invasive interventions. Genomic and proteomic methods offer the possibility of revealing new potential markers, especially for diseases whose biology is complex or not well understood. Panels of markers may be used to accommodate the molecular heterogeneity of cancers. Biomarkers in phase 2 prevention trials of combinations of chemopreventive drugs have been used to demonstrate synergistic action of multiple agents, allowing use of lower doses, with less toxicity, a critical feature of interventions intended for cancer prevention.
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Affiliation(s)
- Barbara K Dunn
- Basic Prevention Science Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892-7340, USA.
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Vogel VG, Costantino JP, Wickerham DL, McCaskill-Stevens W, Clarfeld RB, Grant MD, Wolmark N. Carcinoma in situ outcomes in National Surgical Adjuvant Breast and Bowel Project Breast Cancer Chemoprevention Trials. J Natl Cancer Inst Monogr 2011; 2010:181-6. [PMID: 20956826 DOI: 10.1093/jncimonographs/lgq041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial (BCPT), the reduction in risk of noninvasive breast cancer was 50%. There were 93 cases in women receiving placebo and 60 in those receiving tamoxifen (P = .008). Through 7 years of follow-up, the cumulative incidence of noninvasive breast cancer among the placebo group was 15.8 per 1000 women vs 10.2 per 1000 women in the tamoxifen group. In the initial report of the Study of Tamoxifen and Raloxifene (STAR trial), the rate for noninvasive breast cancer was 1.51 per 1000 women assigned to tamoxifen and 2.11 per 1000 women assigned to raloxifene (risk ratio, 1.40; 95% confidence interval = 0.98 to 2.00). METHODS Additional follow-up of the NSABP STAR trial through March 31, 2009 is reported with a focus on noninvasive breast cancer events. RESULTS Through 81 months of median follow-up in the NSABP STAR trial, there are 137 cases of noninvasive breast cancer in the raloxifene group compared with 111 cases in the tamoxifen group (risk ratio = 1.02, 95% confidence interval = 0.61 to 1.70). The occurrence of ductal carcinoma in situ with raloxifene was seen more frequently among women with lower baseline Gail scores and no atypical hyperplasia than in women taking tamoxifen therapy. Raloxifene retained 76% of the effectiveness of tamoxifen in preventing invasive breast cancer. CONCLUSIONS Although these data indicate that raloxifene offers less protection than tamoxifen for postmenopausal women who are at increased risk for both invasive and noninvasive breast cancer, the favorable risk-benefit profile for raloxifene affords acceptable clinical reduction in the risk of in situ cancers among postmenopausal women.
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Affiliation(s)
- Victor G Vogel
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA.
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Chen JH, Chang YC, Chang D, Wang YT, Nie K, Chang RF, Nalcioglu O, Huang CS, Su MY. Reduction of breast density following tamoxifen treatment evaluated by 3-D MRI: preliminary study. Magn Reson Imaging 2010; 29:91-8. [PMID: 20832226 DOI: 10.1016/j.mri.2010.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
This study analyzed the change in breast density in women receiving tamoxifen treatment using 3-D MRI. Sixteen women were studied. Each woman received breast MRI before and after tamoxifen. The breast and the fibroglandular tissue were segmented using a computer-assisted algorithm, based on T1-weighted images. The fibroglandular tissue volume (FV) and breast volume (BV) were measured and the ratio was calculated as the percent breast density (%BD). The changes in breast volume (ΔBV), fibroglandular tissue volume (ΔFV) and percent density (Δ%BD) between two MRI studies were analyzed and correlated with treatment duration and baseline breast density. The ΔFV showed a reduction in all 16 women. The Δ%BD showed a mean reduction of 5.8%. The reduction of FV was significantly correlated with baseline FV (P<.001) and treatment duration (P=.03). The percentage change in FV was correlated with duration (P=.049). The reduction in %BD was positively correlated with baseline %BD (P=.02). Women with higher baseline %BD showed more reduction of %BD. Three-dimensional MRI may be useful for the measurement of the small changes of ΔFV and Δ%BD after tamoxifen. These changes can potentially be used to correlate with the future reduction of cancer risk.
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Affiliation(s)
- Jeon-Hor Chen
- Tu & Yuen Center for Functional Onco-Imaging and Department of Radiological Science, University of California Irvine, Irvine, CA 92697, USA
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Nie K, Su MY, Chau MK, Chan S, Nguyen H, Tseng T, Huang Y, McLaren CE, Nalcioglu O, Chen JH. Age- and race-dependence of the fibroglandular breast density analyzed on 3D MRI. Med Phys 2010; 37:2770-6. [PMID: 20632587 DOI: 10.1118/1.3426317] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the age- and race-dependence of the breast fibroglandular tissue density based on three-dimensional breast MRI. METHODS The normal breasts of 321 consecutive patients including Caucasians, Asians, and Hispanics were studied. The subjects were separated into three age groups: Younger than 45, between 45 and 55, and older than 55. Computer algorithms based on body landmarks were used to segment the breast, and fuzzy c-means algorithm was used to segment the fibroglandular tissue. Linear regression analysis was applied to compare mean differences among different age groups and race/ethnicity groups. The obtained parameters were not normally distributed, and the transformed data, natural log (ln) for the fibroglandular tissue volume, and the square root for the percent density were used for statistical analysis. RESULTS On the average, the transformed fibroglandular tissue volume and percent density decreased significantly with age. Racial differences in mean transformed percent density were found among women older than 45, but not among women younger than 45. Mean percent density was higher in Asians compared to Caucasians and Hispanics; the difference remained significant after adjustment for age, but not significant after adjusted for both age and breast volume. There was no significant difference in the density between the Caucasians and the Hispanics. CONCLUSIONS The results analyzed using the MRI-based method show age- and race-dependence, which is consistent with literature using mammography-based methods.
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Affiliation(s)
- Ke Nie
- Tu and Yuen Center for Functional Onco-imaging, Irvine, California 92697, USA
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Abstract
OBJECTIVE Breast density is an independent risk factor for the development of invasive breast cancer (BC). It has been hypothesized that because raloxifene (RLX) has been shown to reduce BC risk, its use will result in reduced breast density. METHODS This article provides a review of seven clinical studies that examined the effects of RLX on breast density. RESULTS Overall, RLX did not increase or decrease mammographic breast density. This article provides a review of the various methods used to determine breast density in these RLX studies and offers a potential explanation as to why the studies failed to show an effect on mammographic density. CONCLUSIONS Presently, no clinical recommendations can be made with regard to RLX and its effects on breast density. To determine the effect of RLX on breast density, larger studies need to be conducted in postmenopausal women with high breast density at baseline who are at high risk for BC, with a standardized method of breast density measurement.
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Nie K, Chang D, Chen JH, Shih TC, Hsu CC, Nalcioglu O, Su MY. Impact of skin removal on quantitative measurement of breast density using MRI. Med Phys 2010; 37:227-33. [PMID: 20175485 DOI: 10.1118/1.3271353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In breast MRI, skin and fibroglandular tissue commonly possess similar signal intensities, and as such, the inclusion of skin as dense tissue leads to an overestimation in the measured density. This study investigated the impact of skin to the quantitative measurement of breast density using MRI. METHODS The analysis was performed on the normal breasts of 50 women using nonfat-saturated (nonfat-sat) T1 weighted MR images. The skin was segmented by using a dynamic searching algorithm, which was based on the change in signal intensities from the background air (dark), to the skin (moderate), and then to the fatty tissue (bright). Tissue with moderate intensities that fell between the two boundaries determined based on the intensity gradients (from air to skin, and from skin to fat) was categorized as skin. The percent breast density measured with and without skin exclusion was compared. Also the relationship between the skin volume and the breast volume was investigated. Then, this relationship was used to estimate the skin volume from the breast volume for skin correction. RESULTS The percentage of the skin volume normalized to the breast volume ranged from 5.0% to 15.2% (median 8.6%, mean +/- STD 8.8 +/- 2.6%) among 50 women. The percent breast densities measured with skin (y) and without skin (x) were highly correlated, y = 1.23x+7% (r = 0.94, p < 0.001). The relationship between the skin volume and the breast volume was analyzed based on transformed data (the square root of the skin volume vs the cube root of breast volume) using the linear regression, and yielded r = 0.87, p < 0.001. When this model was used to estimate the skin volume for correction in the density analysis, it provided a better fit to the measured density with skin exclusion (with adjusted R2 = 0.98, and root mean square error = 1.6) compared to the correction done by using a fixed cutoff value of 8% (adjusted R2 = 0.83, root mean square error = 4.7). CONCLUSIONS The authors have shown that the skin volume is related to the breast volume, and this relationship may be used to correct for the skin effect in the MRI-based density measurement. A reliable quantitative density analysis method will aid in clinical investigation to evaluate the role of breast density for cancer risk assessment or for prediction of the efficacy of risk-modifying drugs using hormonal therapy.
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Affiliation(s)
- Ke Nie
- Tu and Yuen Center for Functional Onco-Imaging, University of California, Irvine, California 92697, USA
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Thompson DJ, Leach MO, Kwan-Lim G, Gayther SA, Ramus SJ, Warsi I, Lennard F, Khazen M, Bryant E, Reed S, Boggis CRM, Evans DG, Eeles RA, Easton DF, Warren RML. Assessing the usefulness of a novel MRI-based breast density estimation algorithm in a cohort of women at high genetic risk of breast cancer: the UK MARIBS study. Breast Cancer Res 2009; 11:R80. [PMID: 19903338 PMCID: PMC2815542 DOI: 10.1186/bcr2447] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 09/01/2009] [Accepted: 11/11/2009] [Indexed: 11/29/2022] Open
Abstract
Introduction Mammographic breast density is one of the strongest known risk factors for breast cancer. We present a novel technique for estimating breast density based on 3D T1-weighted Magnetic Resonance Imaging (MRI) and evaluate its performance, including for breast cancer risk prediction, relative to two standard mammographic density-estimation methods. Methods The analyses were based on MRI (n = 655) and mammography (n = 607) images obtained in the course of the UK multicentre magnetic resonance imaging breast screening (MARIBS) study of asymptomatic women aged 31 to 49 years who were at high genetic risk of breast cancer. The MRI percent and absolute dense volumes were estimated using our novel algorithm (MRIBview) while mammographic percent and absolute dense area were estimated using the Cumulus thresholding algorithm and also using a 21-point Visual Assessment scale for one medio-lateral oblique image per woman. We assessed the relationships of the MRI and mammographic measures to one another, to standard anthropometric and hormonal factors, to BRCA1/2 genetic status, and to breast cancer risk (60 cases) using linear and Poisson regression. Results MRI percent dense volume is well correlated with mammographic percent dense area (R = 0.76) but overall gives estimates 8.1 percentage points lower (P < 0.0001). Both show strong associations with established anthropometric and hormonal factors. Mammographic percent dense area, and to a lesser extent MRI percent dense volume were lower in BRCA1 carriers (P = 0.001, P = 0.010 respectively) but there was no association with BRCA2 carrier status. The study was underpowered to detect expected associations between percent density and breast cancer, but women with absolute MRI dense volume in the upper half of the distribution had double the risk of those in the lower half (P = 0.009). Conclusions The MRIBview estimates of volumetric breast density are highly correlated with mammographic dense area but are not equivalent measures; the MRI absolute dense volume shows potential as a predictor of breast cancer risk that merits further investigation.
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Affiliation(s)
- Deborah J Thompson
- Cancer Research UK Genetic Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK.
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Low-dose transdermal estradiol induces breast density and heterogeneity changes comparable to those of raloxifene. Menopause 2009; 16:785-91. [PMID: 19322115 DOI: 10.1097/gme.0b013e318199d07f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of this study was to investigate whether transdermal low-dose estradiol treatment induces changes in mammographic density or heterogeneity compared with raloxifene, whether if these changes relate to changes in bone formation/resorption markers, and whether these findings indicate elevation of breast cancer risk by treatment. METHODS Digitized mammograms of 2 x 135 completers of a 2-year, randomized trial formed the base of the present analysis. Active treatments were transdermal estradiol releasing 0.014 mg estradiol (E2)/week and orally administered raloxifene hydrochloride 60 mg/day, respectively. Influence of the therapies on breast density was assessed with categorical scores Breast Imaging Reporting and Data System, area percentage density, and computer-based (E2-specific) heterogeneity examination of radiographs. These where related to physical and systemic markers. RESULTS At baseline, no mammography scoring methodology or other marker could separate the two treatment groups of transdermal estradiol and raloxifene. No treatment induced significant density changes measured by Breast Imaging Reporting and Data System. Both treatments made the area percentage density increase and the estradiol significantly. Both treatments induced significant changes in E2-specific heterogeneity scoring (E2-specific heterogeneity examination of radiograph), and the raloxifene treatment induced a significantly higher change. At baseline, the mammographic markers showed negative correlation with body mass index and positive correlation with serum type I collagen crosslinks C-telopeptide. The changes in mammographic markers did not essentially exhibit correlations to changes in bone markers in either treatment group. CONCLUSIONS Low-dose transdermal estradiol and raloxifene induced comparable changes in breast density and heterogeneity. Baseline correlations may be explained through relations to obesity. The current study does not yield evidence against the hypothesis that "neither raloxifene nor low dose transdermal estradiol treatment increases the breast cancer risk."
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Abstract
Approximately 7% of women with breast cancer are diagnosed before the age of 40 years, and this disease accounts for more than 40% of all cancer in women in this age group. Survival rates are worse when compared to those in older women, and multivariate analysis has shown younger age to be an independent predictor of adverse outcome. Inherited syndromes, specifically BRCA1 and BRCA2, must be considered when developing treatment algorithms for younger women. Chemotherapy, endocrine, and local therapies have the potential to significantly impact both the physiologic health-including future fertility, premature menopause, and bone health-and the psychological health of young women as they face a diagnosis of breast cancer.
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Affiliation(s)
- Carey K Anders
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599-7305, USA.
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