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Pinker K, Helbich TH, Morris EA. The potential of multiparametric MRI of the breast. Br J Radiol 2016; 90:20160715. [PMID: 27805423 DOI: 10.1259/bjr.20160715] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
MRI is an essential tool in breast imaging, with multiple established indications. Dynamic contrast-enhanced MRI (DCE-MRI) is the backbone of any breast MRI protocol and has an excellent sensitivity and good specificity for breast cancer diagnosis. DCE-MRI provides high-resolution morphological information, as well as some functional information about neoangiogenesis as a tumour-specific feature. To overcome limitations in specificity, several other functional MRI parameters have been investigated and the application of these combined parameters is defined as multiparametric MRI (mpMRI) of the breast. MpMRI of the breast can be performed at different field strengths (1.5-7 T) and includes both established (diffusion-weighted imaging, MR spectroscopic imaging) and novel MRI parameters (sodium imaging, chemical exchange saturation transfer imaging, blood oxygen level-dependent MRI), as well as hybrid imaging with positron emission tomography (PET)/MRI and different radiotracers. Available data suggest that multiparametric imaging using different functional MRI and PET parameters can provide detailed information about the underlying oncogenic processes of cancer development and progression and can provide additional specificity. This article will review the current and emerging functional parameters for mpMRI of the breast for improved diagnostic accuracy in breast cancer.
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Affiliation(s)
- Katja Pinker
- 1 Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,2 Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.,3 Department of Radiology, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas H Helbich
- 2 Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Elizabeth A Morris
- 3 Department of Radiology, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sardanelli F, Carbonaro LA, Montemezzi S, Cavedon C, Trimboli RM. Clinical Breast MR Using MRS or DWI: Who Is the Winner? Front Oncol 2016; 6:217. [PMID: 27840809 PMCID: PMC5083850 DOI: 10.3389/fonc.2016.00217] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/30/2016] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the breast gained a role in clinical practice thanks to the optimal sensitivity of contrast-enhanced (CE) protocols. This approach, first proposed 30 years ago and further developed as bilateral highly spatially resolved dynamic study, is currently considered superior for cancer detection to any other technique. However, other directions than CE imaging have been explored. Apart from morphologic features on unenhanced T2-weighted images, two different non-contrast molecular approaches were mainly run in vivo: proton MR spectroscopy (1H-MRS) and diffusion-weighted imaging (DWI). Both approaches have shown aspects of breast cancer (BC) hidden to CE-MRI: 1H-MRS allowed for evaluating the total choline peak (tCho) as a biomarker of malignancy; DWI showed that restricted diffusivity is correlated with high cellularity and tumor aggressiveness. Secondary evidence on the two approaches is now available from systematic reviews and meta-analyses, mainly considered in this article: pooled sensitivity ranged 71–74% for 1H-MRS and 84–91% for DWI; specificity 78–88% and 75–84%, respectively. Interesting research perspectives are opened for both techniques, including multivoxel MRS and statistical strategies for classification of MR spectra as well as diffusion tensor imaging and intravoxel incoherent motion for DWI. However, when looking at a clinical perspective, while MRS remained a research tool with important limitations, such as relatively long acquisition times, frequent low quality spectra, difficult standardization, and quantification of tCho tissue concentration, DWI has been integrated in the standard clinical protocols of breast MRI and several studies showed its potential value as a stand-alone approach for BC detection.
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Affiliation(s)
- Francesco Sardanelli
- Utà di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Stefania Montemezzi
- Dipartimento di Radiologia, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Carlo Cavedon
- Dipartimento di Fisica Sanitaria, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
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Gillies RJ, Beyer T. PET and MRI: Is the Whole Greater than the Sum of Its Parts? Cancer Res 2016; 76:6163-6166. [PMID: 27729326 DOI: 10.1158/0008-5472.can-16-2121] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/19/2016] [Indexed: 01/22/2023]
Abstract
Over the past decades, imaging in oncology has been undergoing a "quiet" revolution to treat images as data, not as pictures. This revolution has been sparked by technological advances that enable capture of images that reflect not only anatomy, but also of tissue metabolism and physiology in situ Important advances along this path have been the increasing power of MRI, which can be used to measure spatially dependent differences in cell density, tissue organization, perfusion, and metabolism. In parallel, PET imaging allows quantitative assessment of the spatial localization of positron-emitting compounds, and it has also been constantly improving in the number of imageable tracers to measure metabolism and expression of macromolecules. Recent years have witnessed another technological advance, wherein these two powerful modalities have been physically merged into combined PET/MRI systems, appropriate for both preclinical or clinical imaging. As with all new enabling technologies driven by engineering physics, the full extent of potential applications is rarely known at the outset. In the work of Schmitz and colleagues, the authors have combined multiparametric MRI and PET imaging to address the important issue of intratumoral heterogeneity in breast cancer using both preclinical and clinical data. With combined PET and MRI and sophisticated machine-learning tools, they have been able identify multiple coexisting regions ("habitats") within living tumors and, in some cases, have been able to assign these habitats to known histologies. This work addresses an issue of fundamental importance to both cancer biology and cancer care. As with most new paradigm-shifting applications, it is not the last word on the subject and introduces a number of new avenues of investigation to pursue. Cancer Res; 76(21); 6163-6. ©2016 AACR.
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Affiliation(s)
- Robert J Gillies
- Department of Radiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. .,Department of Cancer Imaging, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Thomas Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, General Hospital Vienna, Vienna, Austria
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Grueneisen J, Umutlu L. Lokal- und Ganzkörperdiagnostik weiblicher Beckentumore. Radiologe 2016; 56:605-11. [DOI: 10.1007/s00117-016-0127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leithner D, Baltzer PA, Magometschnigg HF, Wengert GJ, Karanikas G, Helbich TH, Weber M, Wadsak W, Pinker K. Quantitative Assessment of Breast Parenchymal Uptake on 18F-FDG PET/CT: Correlation with Age, Background Parenchymal Enhancement, and Amount of Fibroglandular Tissue on MRI. J Nucl Med 2016; 57:1518-1522. [PMID: 27230924 DOI: 10.2967/jnumed.116.174904] [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: 02/29/2016] [Accepted: 04/12/2016] [Indexed: 01/26/2023] Open
Abstract
Background parenchymal enhancement (BPE), and the amount of fibroglandular tissue (FGT) assessed with MRI have been implicated as sensitive imaging biomarkers for breast cancer. The purpose of this study was to quantitatively assess breast parenchymal uptake (BPU) on 18F-FDG PET/CT as another valuable imaging biomarker and examine its correlation with BPE, FGT, and age. METHODS This study included 129 patients with suspected breast cancer and normal imaging findings in one breast (BI-RADS 1), whose cases were retrospectively analyzed. All patients underwent prone 18F-FDG PET/CT and 3-T contrast-enhanced MRI of the breast. In all patients, interpreter 1 assessed BPU quantitatively using SUVmax Interpreters 1 and 2 assessed amount of FGT and BPE in the normal contralateral breast by subjective visual estimation, as recommended by BI-RADS. Interpreter 1 reassessed all cases and repeated the BPU measurements. Statistical tests were used to assess correlations between BPU, BPE, FGT, and age, as well as inter- and intrainterpreter agreement. RESULTS BPU on 18F-FDG PET/CT varied among patients. The mean BPU SUVmax ± SD was 1.57 ± 0.6 for patients with minimal BPE, 1.93 ± 0.6 for mild BPE, 2.42 ± 0.5 for moderate BPE, and 1.45 ± 0.3 for marked BPE. There were significant (P < 0.001) moderate to strong correlations among BPU, BPE, and FGT. BPU directly correlated with both BPE and FGT on MRI. Patient age showed a moderate to strong indirect correlation with all 3 imaging-derived tissue biomarkers. The coefficient of variation for quantitative BPU measurements with SUVmax was 5.6%, indicating a high reproducibility. Interinterpreter and intrainterpreter agreement for BPE and FGT was almost perfect, with a κ-value of 0.860 and 0.822, respectively. CONCLUSION The results of our study demonstrate that BPU varied among patients. BPU directly correlated with both BPE and FGT on MRI, and BPU measurements were highly reproducible. Patient age showed a strong inverse correlation with all 3 imaging-derived tissue biomarkers. These findings indicate that BPU may serve as a sensitive imaging biomarker for breast cancer prediction, prognosis, and risk assessment.
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Affiliation(s)
- Doris Leithner
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany; and
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Heinrich F Magometschnigg
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Georg J Wengert
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
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Kwon HW, Becker AK, Goo JM, Cheon GJ. FDG Whole-Body PET/MRI in Oncology: a Systematic Review. Nucl Med Mol Imaging 2016; 51:22-31. [PMID: 28250855 DOI: 10.1007/s13139-016-0411-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/01/2016] [Accepted: 03/16/2016] [Indexed: 01/14/2023] Open
Abstract
The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. 18F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.
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Affiliation(s)
- Hyun Woo Kwon
- Department of Nuclear Medicine, Soonchunhyang University Hospital, Cheonan, South Korea
| | | | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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Positron Emission Tomography/Magnetic Resonance Imaging for Local Tumor Staging in Patients With Primary Breast Cancer: A Comparison With Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging. Invest Radiol 2016; 50:505-13. [PMID: 26115367 DOI: 10.1097/rli.0000000000000197] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to assess the diagnostic performance of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) of the breast for lesion detection and local tumor staging of patients with primary breast cancer in comparison to PET/computed tomography (CT) and MRI. MATERIALS AND METHODS The study was approved by the local institutional review board. Forty-nine patients with biopsy-proven invasive breast cancer were prospectively enrolled in our study. All patients underwent a PET/CT, and subsequently, a contrast-enhanced PET/MRI of the breast after written informed consent was obtained before each examination. Two radiologists independently evaluated the corresponding data sets (PET/CT, PET/MRI, and MRI) and were instructed to identify primary tumors lesions as well as multifocal/multicentric and bilateral disease. Furthermore, the occurrence of lymph node metastases was assessed, and the T-stage for each patient was determined. Histopathological verification of the local tumor extent and the axillary lymph node status was available for 30 of 49 and 48 of 49 patients, respectively. For the remaining patients, a consensus characterization was performed for the determination of the T-stage and nodal status, taking into account the results of clinical staging, PET/CT, and PET/MRI examinations. Statistical analysis was performed to test for differences in diagnostic performance between the different imaging procedures. P values less than 0.05 were considered to be statistically significant. RESULTS Positron emission tomography/MRI and MRI correctly identified 47 (96%) of the 49 patients with primary breast cancer, whereas PET/CT enabled detection of 46 (94%) of 49 breast cancer patients and missed a synchronous carcinoma in the contralateral breast in 1 patient. In a lesion-by-lesion analysis, no significant differences could be obtained between the 3 imaging procedures for the identification of primary breast cancer lesions (P > 0.05). Positron emission tomography/MRI and MRI allowed for a correct identification of multifocal/multicentric disease in 3 additional patients if compared with PET/CT. For the definition of the correct T-stage, PET/MRI and MRI showed identical results and were correct in significantly more cases than PET/CT (PET/MRI and MRI, 82%; PET/CT, 68%; P < 0.05). Furthermore, the calculated sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the detection of nodal positive patients (n = 18) were 78%, 94%, 88%, 88%, and 88% for PET/CT; 67%, 87%, 75%, 82%, and 80% for MRI; and 78%, 90%, 82%, 88%, and 86% for PET/MRI, respectively. Differences between the imaging modalities were not statistically significant (P > 0.05). CONCLUSIONS Integrated PET/MRI does not provide diagnostic advantages for local tumor staging of breast cancer patients in comparison to MRI alone. Positron emission tomography/MRI and MRI enable an improved determination of the local tumor extent in comparison to PET/CT, whereas all 3 imaging modalities offer a comparable diagnostic performance for the identification of axillary disease.
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MRI Features of Mucinous Cancer of the Breast: Correlation With Pathologic Findings and Other Imaging Methods. AJR Am J Roentgenol 2016; 206:238-46. [DOI: 10.2214/ajr.15.14851] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Marino MA, Clauser P, Woitek R, Wengert GJ, Kapetas P, Bernathova M, Pinker-Domenig K, Helbich TH, Preidler K, Baltzer PAT. A simple scoring system for breast MRI interpretation: does it compensate for reader experience? Eur Radiol 2015; 26:2529-37. [PMID: 26511631 DOI: 10.1007/s00330-015-4075-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the impact of a scoring system (Tree) on inter-reader agreement and diagnostic performance in breast MRI reading. MATERIALS AND METHODS This IRB-approved, single-centre study included 100 patients with 121 consecutive histopathologically verified lesions (52 malignant, 68 benign). Four breast radiologists with different levels of MRI experience and blinded to histopathology retrospectively evaluated all examinations. Readers independently applied two methods to classify breast lesions: BI-RADS and Tree. BI-RADS provides a reporting lexicon that is empirically translated into likelihoods of malignancy; Tree is a scoring system that results in a diagnostic category. Readings were compared by ROC analysis and kappa statistics. RESULTS Inter-reader agreement was substantial to almost perfect (kappa: 0.643-0.896) for Tree and moderate (kappa: 0.455-0.657) for BI-RADS. Diagnostic performance using Tree (AUC: 0.889-0.943) was similar to BI-RADS (AUC: 0.872-0.953). Less experienced radiologists achieved AUC: improvements up to 4.7 % using Tree (P-values: 0.042-0.698); an expert's performance did not change (P = 0.526). The least experienced reader improved in specificity using Tree (16 %, P = 0.001). No further sensitivity and specificity differences were found (P > 0.1). CONCLUSION The Tree scoring system improves inter-reader agreement and achieves a diagnostic performance similar to that of BI-RADS. Less experienced radiologists, in particular, benefit from Tree. KEY POINTS • The Tree scoring system shows high diagnostic accuracy in mass and non-mass lesions. • The Tree scoring system reduces inter-reader variability related to reader experience. • The Tree scoring system improves diagnostic accuracy in non-expert readers.
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Affiliation(s)
- Maria Adele Marino
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, Azienda Ospedaliero-Universitaria, "S. Maria della Misericordia", P.le Santa Maria della Misericordia, University of Udine, Udine, Italy
| | - Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katja Pinker-Domenig
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna General Hospital, Floor 7F Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Clinical utility of 18F-FDG-PET/MR for preoperative breast cancer staging. Eur Radiol 2015; 26:2297-307. [DOI: 10.1007/s00330-015-4054-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 02/08/2023]
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Pinker K, Baltzer P, Bogner W, Leithner D, Trattnig S, Zaric O, Dubsky P, Bago-Horvath Z, Rudas M, Gruber S, Weber M, Helbich TH. Multiparametric MR Imaging with High-Resolution Dynamic Contrast-enhanced and Diffusion-weighted Imaging at 7 T Improves the Assessment of Breast Tumors: A Feasibility Study. Radiology 2015; 276:360-70. [DOI: 10.1148/radiol.15141905] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Diagnostic accuracy of (18)F-FDG PET/CT compared with that of contrast-enhanced MRI of the breast at 3 T. Eur J Nucl Med Mol Imaging 2015; 42:1656-1665. [PMID: 26121928 DOI: 10.1007/s00259-015-3099-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of prone (18)F-FDG PET/CT with that of contrast-enhanced MRI (CE-MRI) at 3 T in suspicious breast lesions. To evaluate the influence of tumour size on diagnostic accuracy and the use of maximum standardized uptake value (SUVMAX) thresholds to differentiate malignant from benign breast lesions. METHODS A total of 172 consecutive patients with an imaging abnormality were included in this IRB-approved prospective study. All patients underwent (18)F-FDG PET/CT and CE-MRI of the breast at 3 T in the prone position. Two reader teams independently evaluated the likelihood of malignancy as determined by (18)F-FDG PET/CT and CE-MRI independently. (18)F-FDG PET/CT data were qualitatively evaluated by visual interpretation. Quantitative assessment was performed by calculation of SUVMAX. Sensitivity, specificity, diagnostic accuracy, area under the curve and interreader agreement were calculated for all lesions and for lesions <10 mm. Histopathology was used as the standard of reference. RESULTS There were 132 malignant and 40 benign lesions; 23 lesions (13.4%) were <10 mm. Both (18)F-FDG PET/CT and CE-MRI achieved an overall diagnostic accuracy of 93%. There were no significant differences in sensitivity (p = 0.125), specificity (p = 0.344) or diagnostic accuracy (p = 1). For lesions <10 mm, diagnostic accuracy deteriorated to 91% with both (18)F-FDG PET/CT and CE-MRI. Although no significant difference was found for lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than (18)F-FDG PET/CT. Interreader agreement was excellent (κ = 0.85 and κ = 0.92). SUVMAX threshold was not helpful in differentiating benign from malignant lesions. CONCLUSION (18)F-FDG PET/CT and CE-MRI at 3 T showed equal diagnostic accuracies in breast cancer diagnosis. For lesions <10 mm, diagnostic accuracy deteriorated, but was equal for (18)F-FDG PET/CT and CE-MRI at 3 T. For lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than (18)F-FDG PET/CT. Quantitative assessment using an SUVMAX threshold for differentiating benign from malignant lesions was not helpful in breast cancer diagnosis.
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Peng N, Chou C, Pan H, Chang T, Hu C, Chiu Y, Fu T, Chang H. FDG‐PET
/
CT
detection of very early breast cancer in women with breast microcalcification lesions found in mammography screening. J Med Imaging Radiat Oncol 2015; 59:445-452. [DOI: 10.1111/1754-9485.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Nan‐Jing Peng
- Department of Nuclear MedicineKaohsiung Veterans General Hospital Kaohsiung Taiwan
- National Yang‐Ming UniversitySchool of Medicine Taipei Taiwan
| | - Chen‐Pin Chou
- Department of RadiologyKaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Huay‐Ben Pan
- Department of RadiologyKaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Tsung‐Hsien Chang
- Department of Medical Education and ResearchKaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Chin Hu
- Department of Nuclear MedicineKaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Yu‐Li Chiu
- Department of Nuclear MedicineKaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Ting‐Ying Fu
- Department of PathologyKaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Hong‐Tai Chang
- National Yang‐Ming UniversitySchool of Medicine Taipei Taiwan
- Department of SurgeryKaohsiung Veterans General Hospital Kaohsiung Taiwan
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De Palma GD, Esposito D, Luglio G, Limite G, Accurso A, Sollazzo V, Maione F, Cassese G, Siciliano S, Gennarelli N, Ilardi G, Paternoster M, Giglio MC, Forestieri P. Confocal laser endomicroscopy in breast surgery: a pilot study. BMC Cancer 2015; 15:252. [PMID: 25885686 PMCID: PMC4397672 DOI: 10.1186/s12885-015-1245-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/23/2015] [Indexed: 02/03/2023] Open
Abstract
Background Breast neoplasms include different histopathological entities, varying from benign tumors to highly aggressive cancers. Despite the key role of imaging, traditional histology is still required for a definitive diagnosis. Confocal Laser Endomicroscopy (CLE) is a new technique, which enables to obtain histopathological images in vivo, currently used in the diagnosis of gastrointestinal diseases. This is a single-center pilot feasibility study; the main aim is to describe the basic morphological patterns of Confocal Laser Endomicroscopy in normal breast tissue besides benign and malignant lesions. Methods Thirteen female patients (mean age 52.7, range from 22 to 86) who underwent surgical resection for a palpable breast nodule were enrolled. CLE was performed soon after resection with the Cellvizio® Endomicroscopy System (Mauna Kea Technologies, Paris, France), by using a Coloflex UHD-type probe; intravenous fluorescein was used as contrast-enhancing agent. The surgical specimen was cut along the main axis; dynamic images were obtained and recorded using a hand-held probe directly applied both to the internal part of the lesion and to several areas of surrounding normal tissue. Each specimen was then sent for definitive histologic examination. Results Histopathology revealed a benign lesion in six patients (46%), while a breast cancer was diagnosed in seven women (54%). Confocal laser endomicroscopy showed some peculiar morphological patterns. Normal breast tissue was characterized by a honeycomb appearance with regular, dark, round or hexagonal glandular lobules on a bright stroma background; tubular structures, representing ducts or blood vessels, were also visible in some frames. Benign lesions were characterized by a well-demarcated “slit-like” structure or by lobular structures in abundant bright stroma. Finally, breast cancer was characterized by a complete architectural subversion: ductal carcinoma was characterized by ill-defined structures, with dark borders and irregular ductal shape, formingribbons, tubules or nests; mucinous carcinoma showed smaller cells organized in clusters, floating in an amorphous extracellular matrix. Conclusions This is the first pilot study to investigate the potential role of confocal laser imaging as a diagnostic tool in breast diseases. Further studies are required to validate these results and establish the clinical impact of this technique.
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Affiliation(s)
- Giovanni D De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Dario Esposito
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Gaetano Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Gennaro Limite
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Antonello Accurso
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Viviana Sollazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Saverio Siciliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Gennaro Ilardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. .,Department of Advanced Biomedical Sciences, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Mariano Paternoster
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy. .,Department of Advanced Biomedical Sciences, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Mariano C Giglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
| | - Pietro Forestieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II. School of Medicine, Naples, Italy.
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Breast cancer: a new imaging approach as an addition to existing guidelines. Eur J Nucl Med Mol Imaging 2015; 42:813-7. [PMID: 25761830 DOI: 10.1007/s00259-015-3032-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 12/28/2022]
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MedUni Wien Researcher of the month, Jänner 2015. Wien Klin Wochenschr 2015. [DOI: 10.1007/s00508-015-0698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bitencourt AGV, Lima ENP, Chojniak R, Marques EF, Souza JA, Andrade WP, Guimarães MD. Multiparametric evaluation of breast lesions using PET-MRI: initial results and future perspectives. Medicine (Baltimore) 2014; 93:e115. [PMID: 25396329 PMCID: PMC4616313 DOI: 10.1097/md.0000000000000115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic accuracy of multiparametric evaluation of breast lesions combining information of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), and F-fluoro-deoxi-glucose (F-FDG) positron emission tomography/computed tomography (PET-CT). After approval of the institutional research ethics committee, 31 patients with suspicious breast lesions on MRI performed F-FDG PET-CT with a specific protocol for breast evaluation. Patients' mean age was 47.8 years (range, 29-77 years). Positron emission tomography and magnetic resonance imaging (PET-MRI) images were fused. A lesion was considered positive on multiparametric evaluation if at least 1 of the following was present: washout/type 3 kinetic curve on DCE-MRI, restricted diffusion on DWI with minimum apparent diffusion coefficient value <1.00 × 10 mm/s, and abnormal metabolism on F-FDG PET-CT (higher than the physiologic uptake of the normal breast parenchyma). Thirty-eight lesions with histologic correlation were evaluated on the 31 included patients, being 32 mass lesions (84.2%), and 6 nonmass lesions (15.8%). Lesions' mean diameter was 31.1 mm (range, 8-94 mm). Multiparametric evaluation provided 100% sensitivity, 55.5% specificity, 87.9% positive predictive value, 100% negative predictive value, and 89.5% accuracy, with 29 true-positives results, 5 true-negatives, 4 false-positives, and no false-negative results. Multiparametric evaluation with PET-MRI functional data showed good diagnostic accuracy to differentiate benign from malignant breast lesions, reducing the number of unnecessary biopsies, without missing any diagnosis of cancer in our case series.
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Affiliation(s)
- Almir G V Bitencourt
- Department of Imaging (AGVB, ENPL, RC, EFM, JAS, MDG); and Department of Mastology (WPA), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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