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Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US. Eur J Radiol 2014; 83:942-950. [DOI: 10.1016/j.ejrad.2014.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/24/2014] [Accepted: 03/01/2014] [Indexed: 11/21/2022]
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102
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Knuttel FM, Menezes GLG, van den Bosch MAAJ, Gilhuijs KGA, Peters NHGM. Current clinical indications for magnetic resonance imaging of the breast. J Surg Oncol 2014; 110:26-31. [PMID: 24861355 DOI: 10.1002/jso.23655] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/24/2014] [Indexed: 01/17/2023]
Abstract
MRI is increasingly used in breast cancer patients. MRI has a high sensitivity compared to mammography and ultrasound. The specificity is moderate leading to an increased risk of false positive findings. Currently, a beneficial effect of breast MRI has been established in some patient groups and is debated in the general breast cancer population. The diagnostic ability of MRI and its role in various groups of breast cancer patients are discussed in this review.
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Affiliation(s)
- Floor M Knuttel
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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103
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Couch FJ, Nathanson KL, Offit K. Two decades after BRCA: setting paradigms in personalized cancer care and prevention. Science 2014; 343:1466-70. [PMID: 24675953 DOI: 10.1126/science.1251827] [Citation(s) in RCA: 251] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The cloning of the breast cancer susceptibility genes BRCA1 and BRCA2 nearly two decades ago helped set in motion an avalanche of research exploring how genomic information can be optimally applied to identify and clinically care for individuals with a high risk of developing cancer. Genetic testing for mutations in BRCA1, BRCA2, and other breast cancer susceptibility genes has since proved to be a valuable tool for determining eligibility for enhanced screening and prevention strategies, as well as for identifying patients most likely to benefit from a targeted therapy. Here, we discuss the landscape of inherited mutations and sequence variants in BRCA1 and BRCA2, the complexities of determining disease risk when the pathogenicity of sequence variants is uncertain, and current strategies for clinical management of women who carry BRCA1/2 mutations.
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Affiliation(s)
- Fergus J Couch
- Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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104
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O'Flynn EAM, Wilson RM, Allen SD, Locke I, Scurr E, deSouza NM. Diffusion-weighted imaging of the high-risk breast: Apparent diffusion coefficient values and their relationship to breast density. J Magn Reson Imaging 2014; 39:805-11. [PMID: 24038529 DOI: 10.1002/jmri.24243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/03/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To document the apparent diffusion coefficient (ADC) of fibroglandular breast tissue in women at high-risk of developing breast cancer and investigate the relationship between ADC and breast density. MATERIALS AND METHODS Local research ethics approval was obtained. A total of 33 high-risk women including 17 BRCA1/2 mutation carriers (mean age, 43 years) and 16 women postmantle irradiation (mean age 40 years) underwent diffusion-weighted MRI between days 6 and 16 of their menstrual cycle. ADC histograms from a region of interest in fibroglandular tissue and mammographic breast density measurements were obtained. Mean, percentile ADC values (10th, 25th, 50th, 75th, 90th) and skew were compared for the two groups; ADC and mammographic breast density were correlated. RESULTS Mean ADC values (×10(-6) mm(2) /s) were 2017 ± 197 in postmantle irradiated women and 1827 ± 289 in BRCA1/2 mutation carriers (P = 0.035) with significant differences at all percentiles (P < 0.0001) but not skew (P = 0.44). ADC values showed weak positive correlation with mammographic breast density in BRCA1/2 mutation carriers (r = 0.51, P = 0.043) but not in postmantle radiotherapy patients (r = 0.49, P = 0.13). CONCLUSION Higher ADC values seen in fibroglandular tissue postmantle irradiation compared with BRCA1/2 mutation carriers has potential to improve tumor detection in these patients. Lack of correlation between ADC and breast density postmantle irradiation may be a result of microstructural changes.
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Affiliation(s)
- Elizabeth A M O'Flynn
- Clinical Magnetic Resonance Group, Cancer Research UK and EPSRC Cancer Imaging Centre, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, United Kingdom
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105
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Abstract
When used for appropriate indications, breast magnetic resonance imaging (MRI) is a powerful diagnostic tool. However, breast MRI has its share of controversies. These controversies can be a source of confusion for the radiologist or referring physician. This paper addresses 4 breast MRI controversies that we frequently encounter at our university hospital practice: (1) what are the appropriate indications for screening breast MRI? (2) what are the appropriate indications for the use of breast MRI as a problems-solving modality? (3) how does one interpret MRI imaging features that have substantial overlap between benign and malignant conditions? and (4) what are the appropriate indications for preoperative breast MRI? Illustrative case examples are provided.
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Affiliation(s)
- Joseph B Sutcliffe
- Department of Radiology, University of Texas Health Science Center in San Antonio, San Antonio, TX 78229, USA.
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106
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Yang Q, Li L, Zhang J, Shao G, Zhang C, Zheng B. Computer-aided diagnosis of breast DCE-MRI images using bilateral asymmetry of contrast enhancement between two breasts. J Digit Imaging 2014; 27:152-60. [PMID: 24043592 PMCID: PMC3903971 DOI: 10.1007/s10278-013-9617-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Dynamic contrast material-enhanced magnetic resonance imaging (DCE-MRI) of breasts is an important imaging modality in breast cancer diagnosis with higher sensitivity but relatively lower specificity. The objective of this study is to investigate a new approach to help improve diagnostic performance of DCE-MRI examinations based on the automated detection and analysis of bilateral asymmetry of characteristic kinetic features between the left and right breast. An image dataset involving 130 DCE-MRI examinations was assembled and used in which 80 were biopsy-proved malignant and 50 were benign. A computer-aided diagnosis (CAD) scheme was developed to segment breast areas depicted on each MR image, register images acquired from the sequential MR image scan series, compute average contrast enhancement of all pixels in one breast, and a set of kinetic features related to the difference of contrast enhancement between the left and right breast, and then use a multi-feature based Bayesian belief network to classify between malignant and benign cases. A leave-one-case-out validation method was applied to test CAD performance. The computed area under a receiver operating characteristic (ROC) curve is 0.78 ± 0.04. The positive and negative predictive values are 0.77 and 0.64, respectively. The study indicates that bilateral asymmetry of kinetic features between the left and right breasts is a potentially useful image biomarker to enhance the detection of angiogenesis associated with malignancy. It also demonstrates the feasibility of applying a simple CAD approach to classify between malignant and benign DCE-MRI examinations based on this new image biomarker.
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Affiliation(s)
- Qian Yang
- />College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 China
| | - Lihua Li
- />College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 China
- />Department of Biomedical Engineering, College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 China
| | - Juan Zhang
- />Zhejiang Cancer Hospital, Hangzhou, China
| | | | - Chengjie Zhang
- />College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 China
| | - Bin Zheng
- />College of Life Information Science and Instrument Engineering, Hangzhou Dianzi University, Hangzhou, 310018 China
- />School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 USA
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107
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Hollingsworth AB, Stough RG. An alternative approach to selecting patients for high-risk screening with breast MRI. Breast J 2014; 20:192-7. [PMID: 24387050 DOI: 10.1111/tbj.12242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Current guidelines for adding breast MRI to annual screening mammography are based entirely upon stratification of risk, with a heavy focus on lifetime calculations. This approach is fraught with difficulty due to the reliance on mathematical models that vary widely in their calculations, the inherent age discrimination of using lifetime risks rather than short-term incidence, and the failure to incorporate mammographic density, the latter being an independent risk as well as the greatest predictor of mammographic failure. By utilizing a system of patient selection similar to what was used in the American College of Radiology Imaging Network (ACRIN) 6666 trial for multi-modality imaging, 33 women without a prior diagnosis of breast cancer were found to harbor mammographically occult carcinoma through MRI screening. These 33 patients represent a 2% yield, closely approximating the yields seen in prospective MRI screening trials of women at very high risk of breast cancer. Using the "~20-25%" minimum established by the American Cancer Society and later the National Comprehensive Cancer Network, the Gail model would have prompted the use of MRI in only 9 of 33 (27.3%) patients, the Claus model 1 of 33 (3%), and the Tyrer-Cuzick model 12 of 33 (36.4%). Using all three models and opting for the highest calculated risk, then including BRCA-positivity, still would have identified only 16 of 33 (48.5%) patients with occult breast cancer discovered by MRI. Only one patient was BRCA-positive, and none had lobular carcinoma in situ, while 6 of 33 patients (18.2%) had atypical ductal hyperplasia (ADH). Measures are proposed to refine patient selection for MRI screening through the use of short-term or categorical risks, mammographic density, while maintaining cost-effectiveness through longer MRI screening intervals.
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108
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Affiliation(s)
- Constance D Lehman
- University of Washington and Seattle Cancer Care Alliance, Seattle, WA 98109, USA.
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109
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Lee CI, Grauke LJ, Sandhir V, DeMartini WB, Newstead GM, Peacock S, Lehman CD. Radiologists' Performance in the ACR Breast MR With Guided Biopsy Course. J Am Coll Radiol 2013; 10:854-8. [DOI: 10.1016/j.jacr.2013.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
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Price ER, Hargreaves J, Lipson JA, Sickles EA, Brenner RJ, Lindfors KK, Joe BN, Leung JWT, Feig SA, Bassett LW, Ojeda-Fournier H, Daniel BL, Kurian AW, Love E, Ryan L, Walgenbach DD, Ikeda DM. The California breast density information group: a collaborative response to the issues of breast density, breast cancer risk, and breast density notification legislation. Radiology 2013; 269:887-92. [PMID: 24023072 DOI: 10.1148/radiol.13131217] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In anticipation of breast density notification legislation in the state of California, which would require notification of women with heterogeneously and extremely dense breast tissue, a working group of breast imagers and breast cancer risk specialists was formed to provide a common response framework. The California Breast Density Information Group identified key elements and implications of the law, researching scientific evidence needed to develop a robust response. In particular, issues of risk associated with dense breast tissue, masking of cancers by dense tissue on mammograms, and the efficacy, benefits, and harms of supplementary screening tests were studied and consensus reached. National guidelines and peer-reviewed published literature were used to recommend that women with dense breast tissue at screening mammography follow supplemental screening guidelines based on breast cancer risk assessment. The goal of developing educational materials for referring clinicians and patients was reached with the construction of an easily accessible Web site that contains information about breast density, breast cancer risk assessment, and supplementary imaging. This multi-institutional, multidisciplinary approach may be useful for organizations to frame responses as similar legislation is passed across the United States. Online supplemental material is available for this article.
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Affiliation(s)
- Elissa R Price
- From the Departments of Radiology and Biomedical Imaging, Division of Women's Imaging (E.R.P., E.A.S., B.N.J.), and Radiology (R.J.B.), University of California, San Francisco, San Francisco, Calif; Department of Radiology (J.H, K.K.L.) and the Comprehensive Cancer Center (D.D.W.), University of California, Davis, Sacramento, Calif; Department of Radiology, Stanford University School of Medicine, Advanced Medicine Center, 875 Blake Wilbur Dr, Room CC-2239, Stanford, Calif (J.A.L., D.M.I.); Bay Imaging Consultants, Sutter Health, Alta Bates Summitt Medical Center, Carol Ann Read Breast Health Center, Oakland, Calif (R.J.B.); Department of Radiology, Sutter Health, California Pacific Medical Center, San Francisco, Calif (J.W.T.L.); Department of Radiology, University of California, Irvine Medical Center, Fong and Jean Tsai Professor of Women's Imaging, University of California Irvine School of Medicine, UCI Medical Center, Orange, Calif (S.A.F.); Department of Radiology, University of California, Los Angeles, Los Angeles, Calif (L.W.B.); Department of Clinical Radiology, Moores Cancer Center, UC San Diego Health System, La Jolla, Calif (H.O.F.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (B.L.D.); Divisions of Oncology and Epidemiology, Stanford University School of Medicine, Stanford, Calif (A.W.K.); Department of OB/GYN, UC Davis Health System, University of California Davis Cancer Center, Sacramento, Calif (E.L.); and Athena Breast Health Network and UCSF Cancer Risk Program, San Francisco, Calif (L.R.)
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111
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Williams M, Eatrides J, Kim J, Talwar H, Esposito N, Szabunio M, Ismail-Khan R, Kiluk J, Lee M, Laronga C, Khakpour N. Comparison of breast magnetic resonance imaging clinical tumor size with pathologic tumor size in patients status post-neoadjuvant chemotherapy. Am J Surg 2013; 206:567-73. [DOI: 10.1016/j.amjsurg.2013.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 12/06/2012] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
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JOURNAL CLUB: Is Screening MRI Indicated for Women With a Personal History of Breast Cancer? Analysis Based on Biopsy Results. AJR Am J Roentgenol 2013; 201:919-27. [DOI: 10.2214/ajr.11.8450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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113
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Tagliafico AS, Tagliafico G, Cavagnetto F, Calabrese M, Houssami N. Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories. Br J Radiol 2013; 86:20130255. [PMID: 24029631 DOI: 10.1259/bjr.20130255] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare breast density estimated from two-dimensional full-field digital mammography (2D FFDM) and from digital breast tomosynthesis (DBT) according to different Breast Imaging-Reporting and Data System (BI-RADS) categories, using automated software. METHODS Institutional review board approval and written informed patient consent were obtained. DBT and 2D FFDM were performed in the same patients to allow within-patient comparison. A total of 160 consecutive patients (mean age: 50±14 years; mean body mass index: 22±3) were included to create paired data sets of 40 patients for each BI-RADS category. Automatic software (MedDensity(©), developed by Giulio Tagliafico) was used to compare the percentage breast density between DBT and 2D FFDM. The estimated breast percentage density obtained using DBT and 2D FFDM was examined for correlation with the radiologists' visual BI-RADS density classification. RESULTS The 2D FFDM differed from DBT by 16.0% in BI-RADS Category 1, by 11.9% in Category 2, by 3.5% in Category 3 and by 18.1% in Category 4. These differences were highly significant (p<0.0001). There was a good correlation between the BI-RADS categories and the density evaluated using 2D FFDM and DBT (r=0.56, p<0.01 and r=0.48, p<0.01, respectively). CONCLUSION Using DBT, breast density values were lower than those obtained using 2D FFDM, with a non-linear relationship across the BI-RADS categories. These data are relevant for clinical practice and research studies using density in determining the risk. ADVANCES IN KNOWLEDGE On DBT, breast density values were lower than with 2D FFDM, with a non-linear relationship across the classical BI-RADS categories.
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Affiliation(s)
- A S Tagliafico
- Department of Experimental Medicine, University of Genova, Genova, Italy
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114
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Gold LS, Buist DS, Loggers ET, Etzioni R, Kessler L, Ramsey SD, Sullivan SD. Advanced diagnostic breast cancer imaging: variation and patterns of care in Washington state. J Oncol Pract 2013; 9:e194-202. [PMID: 23943885 PMCID: PMC3770510 DOI: 10.1200/jop.2012.000796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Because receipt of breast imaging likely occurs in nonrandom patterns, selection bias is an important issue in studies that attempt to elucidate associations between imaging and breast cancer outcomes. The purpose of this study was to analyze use of advanced diagnostic imaging in a cohort of patients with breast cancer insured by commercial, managed care, and public health plans by demographic, health insurance, and clinical variables from 2002 to 2009. METHODS We identified women with breast cancer diagnoses from a Surveillance Epidemiology and End Results (SEER) registry whose data could be linked to claims from participating health plans. We examined imaging that occurred between cancer diagnosis and initiation of treatment and classified patients according to receipt of (1) mammography or ultrasound only; (2) breast magnetic resonance imaging (MRI); and (3) other advanced imaging (computed tomography [CT] of the chest, abdoment, and pelvis; positron emission tomography [PET]; or PET-CT). We used logistic regression to identify factors associated with receipt of breast MRI as well as other advanced imaging. RESULTS Commercial health plan, younger age, and later year of diagnosis were strongly associated with receipt of breast MRI and other advanced imaging. Women with prescription drug plans and those who had less comorbidities were more likely to have received breast MRI. CONCLUSION Use of breast MRI and other advanced imaging is increasing among patients newly diagnosed with breast cancer; individual patient and insurance-related factors are associated with receipt of these imaging tests. Whether use of diagnostic advanced imaging affects outcomes such as re-excision, cancer recurrence, mortality rates, and costs of breast cancer treatment remains to be determined.
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Affiliation(s)
- Laura S. Gold
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Diana S.M. Buist
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth T. Loggers
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ruth Etzioni
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Larry Kessler
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Scott D. Ramsey
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sean D. Sullivan
- School of Pharmacy, University of Washington; School of Public Health, University of Washington; Group Health Research Institute, Group Health Cooperative; and Fred Hutchinson Cancer Research Center, Seattle, WA
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115
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Giess CS, Raza S, Birdwell RL. Patterns of Nonmasslike Enhancement at Screening Breast MR Imaging of High-Risk Premenopausal Women. Radiographics 2013; 33:1343-60. [DOI: 10.1148/rg.335125185] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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116
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MRI-guided vacuum-assisted breast biopsy: comparison with stereotactically guided and ultrasound-guided techniques. Eur Radiol 2013; 24:128-35. [PMID: 23979106 PMCID: PMC3889280 DOI: 10.1007/s00330-013-2989-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/26/2013] [Accepted: 07/09/2013] [Indexed: 11/24/2022]
Abstract
Objectives To analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB. Methods We performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided. Results MRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35). Conclusion MRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings. Key points • Three vacuum-assisted breast biopsy (VAB) procedures were compared. • Technical success rates were high for all three VAB procedures. • Medical complications were relatively low using all three VAB procedures. • The use of MRI-guided vacuum-assisted breast biopsy is growing.
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117
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Sung JS, Dershaw DD. Breast Magnetic Resonance Imaging for Screening High-Risk Women. Magn Reson Imaging Clin N Am 2013; 21:509-17. [DOI: 10.1016/j.mric.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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118
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Brasic N, Wisner DJ, Joe BN. Breast MR Imaging for Extent of Disease Assessment in Patients with Newly Diagnosed Breast Cancer. Magn Reson Imaging Clin N Am 2013; 21:519-32. [DOI: 10.1016/j.mric.2013.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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119
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Mainiero MB, Lourenco A, Mahoney MC, Newell MS, Bailey L, Barke LD, D'Orsi C, Harvey JA, Hayes MK, Huynh PT, Jokich PM, Lee SJ, Lehman CD, Mankoff DA, Nepute JA, Patel SB, Reynolds HE, Sutherland ML, Haffty BG. ACR Appropriateness Criteria Breast Cancer Screening. J Am Coll Radiol 2013; 10:11-4. [PMID: 23290667 DOI: 10.1016/j.jacr.2012.09.036] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Mammography is the recommended method for breast cancer screening of women in the general population. However, mammography alone does not perform as well as mammography plus supplemental screening in high-risk women. Therefore, supplemental screening with MRI or ultrasound is recommended in selected high-risk populations. Screening breast MRI is recommended in women at high risk for breast cancer on the basis of family history or genetic predisposition. Ultrasound is an option for those high-risk women who cannot undergo MRI. Recent literature also supports the use of breast MRI in some women of intermediate risk, and ultrasound may be an option for intermediate-risk women with dense breasts. There is insufficient evidence to support the use of other imaging modalities, such as thermography, breast-specific gamma imaging, positron emission mammography, and optical imaging, for breast cancer screening. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Miesfeldt S, Lamb A, Duarte C. Management of genetic syndromes predisposing to gynecologic cancers. Curr Treat Options Oncol 2013; 14:34-50. [PMID: 23315239 DOI: 10.1007/s11864-012-0215-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Women with personal and family histories consistent with gynecologic cancer-associated hereditary cancer susceptibility disorders should be referred for genetic risk assessment and counseling. Genetic counseling facilitates informed medical decision making regarding genetic testing, screening, and treatment, including chemoprevention and risk-reducing surgery. Because of limitations of ovarian cancer screening, hereditary breast and ovarian cancer-affected women are offered risk-reducing bilateral salpingo-oophorectomy (BSO) between ages 35 and 40 years, or when childbearing is complete. Women with documented Lynch syndrome, associated with mutations in mismatch repair genes, should be screened at a young age and provided prevention options, including consideration of risk-reducing total abdominal hysterectomy and BSO, as well as intensive gastrointestinal screening. Clinicians caring for high-risk women must consider the potential adverse ethical, legal, and social issues associated with hereditary cancer risk assessment and testing. Additionally, at-risk family members should be alerted to their cancer risks, as well as the availability of risk assessment, counseling, and treatment services.
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Affiliation(s)
- Susan Miesfeldt
- Cancer Risk and Prevention Program, Maine Medical Center Cancer Institute, Scarborough, ME 04074, USA.
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Abstract
Data support greater sensitivity of MR imaging compared with mammography and ultrasound in high-risk populations, in particular BRCA 1 and BRCA 2 carriers. Screening ultrasound improves cancer yield versus mammography alone in high-risk patients and in patients with dense breasts and is less expensive. Drawbacks include low positive predictive value, operator dependence, and significant physician time expenditure. Advances, such as refinement of automated whole-breast ultrasound, new outcomes data from ultrasound-detected masses in BI-RADS 3 and 4a categories, and development of new MR imaging sequences that allow rapid screening, potentially without use of contrast, will likely reveal the most appropriate tool over time.
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Hofstatter EW, Andrejeva L, Chagpar AB. State of the Art in Imaging and Chemoprevention for High-Risk Patients. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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123
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Schmidt MA, Borri M, Scurr E, Ertas G, Payne G, O'Flynn E, Desouza N, Leach MO. Breast dynamic contrast-enhanced examinations with fat suppression: are contrast-agent uptake curves affected by magnetic field inhomogeneity? Eur Radiol 2013; 23:1537-45. [PMID: 23242002 DOI: 10.1007/s00330-012-2735-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/14/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the effect of magnetic field heterogeneity in breast dynamic contrast-enhanced examinations with fat saturation (DCE-FS). METHODS The magnetic field was mapped over the breasts in ten patients. DCE-FS was undertaken at 1.5 T with fast spoiled gradient echoes and spectrally selective fat saturation. Signal intensity was calculated for T1 values 25-1,200 ms both on and off resonance, and results were verified with a test object. Clinical examinations were evaluated for the predicted effects of field heterogeneity. RESULTS Magnetic field was found to vary by 3.6 ± 1.2 ppm over the central transaxial slice and 5.1 ± 1.5 over the whole breast volume (mean ± standard deviation). Computer simulations predict a reduction in the dynamic range if field heterogeneity leads to unintended water suppression, and distortion to CA uptake curves due to fat suppression failure (for fat containing pixels). A compromise between dynamic range and fat saturation performance is required. Both water suppression and fat suppression failure are apparent in clinical examinations. CONCLUSION Magnetic field heterogeneity is likely to reduce the sensitivity of DCE-FS by distorting the CA uptake curves because of fat suppression failure (for fat containing pixels) and by reducing the dynamic range because of unintended water suppression. KEY POINTS • Magnetic field heterogeneity is significant in breast magnetic resonance. • Contrast-agent uptake curves are distorted by a non-uniform magnetic field. • Radiologist must be aware of possibility of distortion to interpret uptake curves correctly. • Compromise between fat suppression and dynamic range is required.
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Affiliation(s)
- Maria A Schmidt
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, MRI Unit, Downs Rd, Sutton SM2 5 PT, UK.
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Barreau B, Paillet-Pontier C, Scarwell-Prévost C, Lerdou G, Gaüzère R, Joyeux P. Surveillance des cancers du sein selon l’âge : la femme jeune. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.04.001] [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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125
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Particularités de l’imagerie des cancers du sein chez les femmes jeunes et mutées. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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126
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Euhus DM, Robinson L. Genetic Predisposition Syndromes and Their Management. Surg Clin North Am 2013; 93:341-62. [DOI: 10.1016/j.suc.2013.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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127
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Multimodality GPU-based computer-assisted diagnosis of breast cancer using ultrasound and digital mammography images. Int J Comput Assist Radiol Surg 2013; 8:547-60. [DOI: 10.1007/s11548-013-0813-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/08/2013] [Indexed: 02/04/2023]
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128
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Kam JKP, Naidu P, Rose AK, Mann GB. Five-year analysis of magnetic resonance imaging as a screening tool in women at hereditary risk of breast cancer. J Med Imaging Radiat Oncol 2013; 57:400-6. [PMID: 23870334 DOI: 10.1111/1754-9485.12030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/21/2012] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Women at very high risk of breast cancer are recommended to undertake enhanced surveillance with annual MRI in addition to mammography. We aimed to review the performance of breast MRI as a screening modality over its first 5 years at our institution. METHODS The study used a retrospective review using prospectively collected data from a consecutive series of women at high risk of developing breast cancer undergoing surveillance MRI. RESULTS Two hundred twenty-three women had at least one screening MRI. The median age was 42 years old. Sixty-nine (30.9%) were confirmed genetic mutation carriers. The remaining 154 (69.1%) women were classified as high risk based on family history, without a confirmed genetic mutation. Three hundred forty screening MRI studies were performed. Of these, 69 patients (20.3%) were recalled for further assessment. There was a significant reduction in the recall rate throughout the study for prevalent screens, from 50% (17/34) in 2008 to 14% (9/54) in 2011 (P = 0.004). The overall biopsy rate was 39 in 340 screens (11.5%). Four cancers were identified. Three were in confirmed BRCA1/BRCA2 mutation carriers, and one was found to be a carrier after the cancer was diagnosed. All four were identified as suspicious on MRI, with two having normal mammography. The cancer detection rate of MRI was 1.2% (4/340 screens). The overall positive predictive value was 7.0%, 6.7% for prevalent screens and 7.1% for subsequent screens. CONCLUSIONS Breast MRI as a screening modality for malignant lesions in women with high hereditary risk is valuable. The recall rate, especially in the prevalent round, improved with radiologist experience.
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Affiliation(s)
- Jeffrey K P Kam
- The Breast Service, The Royal Melbourne and The Royal Women's Hospitals, Melbourne, Victoria, Australia
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129
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Urban LABD, Schaefer MB, Duarte DL, Santos RPD, Maranhão NMDA, Kefalas AL, Canella EDO, Ferreira CAP, Peixoto JE, Chala LF, Costa RP, Francisco JLE, Martinelli SE, Amorim HLED, Pasqualette HA, Pereira PMS, Camargo Junior HSAD, Sondermann VR. Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para rastreamento do câncer de mama por métodos de imagem. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000600009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lee CI, Bassett LW, Lehman CD. Breast density legislation and opportunities for patient-centered outcomes research. Radiology 2012; 264:632-6. [PMID: 22919037 DOI: 10.1148/radiol.12120184] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA 98109-1023, USA.
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131
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Cott Chubiz JE, Lee JM, Gilmore ME, Kong CY, Lowry KP, Halpern EF, McMahon PM, Ryan PD, Gazelle GS. Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers. Cancer 2012. [PMID: 23184400 DOI: 10.1002/cncr.27864] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Current clinical guidelines recommend earlier, more intensive breast cancer screening with both magnetic resonance imaging (MRI) and mammography for women with breast cancer susceptibility gene (BRCA) mutations. Unspecified details of screening schedules are a challenge for implementing guidelines. METHODS A Markov Monte Carlo computer model was used to simulate screening in asymptomatic women who were BRCA1 and BRCA2 mutation carriers. Three dual-modality strategies were compared with digital mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals beginning at age 25 years (Alt25), 2) annual MRI beginning at age 25 years with alternating DM added at age 30 years (MRI25/Alt30), and 3) DM and MRI alternating at 6-month intervals beginning at age 30 years (Alt30). Primary outcomes were quality-adjusted life years (QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness (dollars per QALY gained). Additional outcomes included potential harms of screening, and lifetime costs stratified into component categories (screening and diagnosis, treatment, mortality, and patient time costs). RESULTS All 3 dual-modality screening strategies increased QALYs and costs. Alt30 screening had the lowest incremental costs per additional QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY). False-positive test results increased substantially with dual-modality screening and occurred more frequently in BRCA2 carriers. Downstream savings in both breast cancer treatment and mortality costs were outweighed by increases in up-front screening and diagnosis costs. The results were influenced most by estimates of breast cancer risk and MRI costs. CONCLUSIONS Alternating MRI and DM screening at 6-month intervals beginning at age 30 years was identified as a clinically effective approach to applying current guidelines, and was more cost-effective in BRCA1 gene mutation carriers compared with BRCA2 gene mutation carriers.
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Affiliation(s)
- Jessica E Cott Chubiz
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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132
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Evaluation of tissue sampling methods used for MRI-detected contralateral breast lesions in the American College of Radiology Imaging Network 6667 trial. AJR Am J Roentgenol 2012; 199:W386-91. [PMID: 22915431 DOI: 10.2214/ajr.11.7000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate tissue sampling methods used for MRI-detected suspicious contralateral breast lesions in the American College of Radiology Imaging Network (ACRIN) 6667 trial. MATERIALS AND METHODS Breast MRI was performed at 25 institutions in 969 women who had a recent diagnosis of unilateral breast cancer and negative contralateral mammography and clinical breast examinations. Biopsy was recommended for MRI findings in 135 women, and 121 underwent sampling. Frequencies and positive biopsy rates of sampling methods used for initial diagnosis and imaging guidance techniques were calculated and compared. RESULTS Sampling yielded 30 malignant and 91 benign results. Initial sampling used needle biopsy in 88 of 121 (72.7%) and surgical biopsy in 30 of 121 (24.8%) women. Surgical biopsy was excisional biopsy in 28 of 30 (93.3%) and mastectomy in two of 30 (6.7%). The remaining three of 121 (2.5%) women underwent mastectomy, but it was not documented whether this represented initial tissue sampling. Of imaging-guided procedures, 56 of 106 (52.8%) used MRI; 49 of 106 (46.2%), ultrasound; and one of 106 (1.0%), stereotaxis. MRI-guided sampling was with needle biopsy rather than wire-localized surgical biopsy in 33 of 56 (58.9%) women, whereas ultrasound used needle biopsy in 47 of 49 (95.9%). Positive biopsy rates of sampling methods were 20.5% for needle biopsy, 46.2% for excisional biopsy, and 0% for mastectomy. CONCLUSION The majority of initial biopsies for MRI-detected contralateral breast lesions used needle biopsy rather than surgical biopsy. Contralateral surgery could have been avoided in most cases had needle biopsy been performed because most excisional biopsy and all mastectomy results were benign. MRI-guided biopsy was significantly more likely than ultrasound-guided sampling to use wire-localized surgical biopsy rather than needle biopsy.
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133
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Alonso Roca S, Jiménez Arranz S, Delgado Laguna A, Quintana Checa V, Grifol Clar E. Breast cancer screening in high risk populations. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leong LCH, Gogna A, Pant R, Ng FC, Sim LSJ. Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n10p432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Dense breasts are common in Asian women and they limit the sensitivity of mammography. This study evaluates the performance of supplementary breast ultrasound screening in Asian women with dense mammograms. Materials and Methods: The study was approved by the hospital’s Institutional Review Board. A prospective clinical trial was performed between September 2002 and November 2004. Asymptomatic Asian women with negative and dense mammograms were offered supplementary ultrasound screening for breast cancer. Ultrasound assessment was categorised as U1 to U4. U1 and U2 cases were recommended routine interval screening mammography. U3 cases were recommended follow-up ultrasound in 6 months and routine interval screening mammography and U4 cases were recommended biopsy. Results: One hundred and forty-one women with mean age of 45.1 years were enrolled into the study. Mean scan time was 13.0 minutes (± 5.6 minutes) for bilateral vs 11.0 minutes (± 1.4 minutes) for unilateral scans. There were 10 patients and 14 patients in the in the U3 and U4 categories, respectively. Two U4 category patients were diagnosed with malignancy—a-6 mm ductal carcinoma-in-situ and a 13-mm invasive ductal carcinoma. The breast cancer detection rate was 1.4%. Sensitivity and specificity were 100% (2/2) and 88.5% (92/104) respectively. The positive predictive value was 14.3% (2/14) and the negative predictive value was 100% (92/92). Conclusion: This pilot study reveals the usefulness of supplementary ultrasound screening in detecting early stage mammographically and clinically occult breast cancers in Asian women with dense breasts. A larger long-term study is, however, needed to assess its feasibility and impact on breast cancer prognosis.
Key words: Asian, Breast, Dense, Screening, Ultrasound
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Affiliation(s)
| | | | - Rita Pant
- King Faisal Specialist Hospital and Research Centre. Riyadh, Saudi Arabia
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135
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Evaluating surveillance breast imaging and biopsy in older breast cancer survivors. Int J Breast Cancer 2012; 2012:347646. [PMID: 23097709 PMCID: PMC3477570 DOI: 10.1155/2012/347646] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/24/2012] [Indexed: 11/20/2022] Open
Abstract
Background. Patterns of surveillance among breast cancer survivors are not well characterized and lack evidence-based practice guidelines, particularly for imaging modalities other than mammography. We characterized breast imaging and related biopsy longitudinally among breast cancer survivors in relation to women's characteristics.
Methods. Using data from a state-wide (New Hampshire) breast cancer screening registry linked to Medicare claims, we examined use of mammography, ultrasound (US), magnetic resonance imaging (MRI), and biopsy among breast cancer survivors. We used generalized estimating equations (GEE) to model associations of breast surveillance with women's characteristics. Results. The proportion of women with mammography was high over the follow-up period (81.5% at 78 months), but use of US or MRI was much lower (8.0%—first follow-up window, 4.7% by 78 months). Biopsy use was consistent throughout surveillance periods (7.4%–9.4%). Surveillance was lower among older women and for those with a higher stage of diagnosis. Primary therapy was significantly associated with greater likelihood of breast surveillance. Conclusions. Breast cancer surveillance patterns for mammography, US, MRI, and related biopsy seem to be associated with age, stage, and treatment, but need a larger evidence-base for clinical recommendations.
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Hillman BJ, Harms SE, Stevens G, Stough RG, Hollingsworth AB, Kozlowski KF, Moss LJ. Diagnostic Performance of a Dedicated 1.5-T Breast MR Imaging System. Radiology 2012; 265:51-8. [DOI: 10.1148/radiol.12110600] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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137
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Freitas V, Scaranelo A, Menezes R, Kulkarni S, Hodgson D, Crystal P. Added cancer yield of breast magnetic resonance imaging screening in women with a prior history of chest radiation therapy. Cancer 2012; 119:495-503. [DOI: 10.1002/cncr.27771] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/17/2012] [Accepted: 07/17/2012] [Indexed: 01/11/2023]
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138
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Urban L, Urban C. Role of Mammography versus Magnetic Resonance Imaging for Breast Cancer Screening. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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139
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Fausto A, Casella D, Mantovani L, Giacalone G, Volterrani L. Clinical value of second-look ultrasound: Is there a way to make it objective? Eur J Radiol 2012; 81 Suppl 1:S36-40. [DOI: 10.1016/s0720-048x(12)70015-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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140
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Terenziani M, Casalini P, Scaperrotta G, Gandola L, Trecate G, Catania S, Cefalo G, Conti A, Massimino M, Meazza C, Podda M, Spreafico F, Suman L, Gennaro M. Occurrence of breast cancer after chest wall irradiation for pediatric cancer, as detected by a multimodal screening program. Int J Radiat Oncol Biol Phys 2012; 85:35-9. [PMID: 22677366 DOI: 10.1016/j.ijrobp.2012.03.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 02/27/2012] [Accepted: 03/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program. PATIENTS AND METHODS We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment. RESULTS Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%. CONCLUSIONS Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.
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Affiliation(s)
- Monica Terenziani
- Pediatric Oncology Unit, Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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141
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Alonso Roca S, Jiménez Arranz S, Delgado Laguna AB, Quintana Checa V, Grifol Clar E. [Breast cancer screening in high risk populations]. RADIOLOGIA 2012; 54:490-502. [PMID: 22579381 DOI: 10.1016/j.rx.2011.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 11/16/2011] [Accepted: 11/16/2011] [Indexed: 11/28/2022]
Abstract
We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines).
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Affiliation(s)
- S Alonso Roca
- Sección de mama, Servicio de Diagnóstico por Imagen, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
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142
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Outcome of MRI-guided vacuum-assisted breast biopsy - initial experience at Institute of Oncology Ljubljana, Slovenia. Radiol Oncol 2012; 46:97-105. [PMID: 23077445 PMCID: PMC3472934 DOI: 10.2478/v10019-012-0016-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/28/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Like all breast imaging modalities MRI has limited specificity and the positive predictive value for lesions detected by MRI alone ranges between 15 and 50%. MRI guided procedures (needle biopsy, presurgical localisation) are mandatory for suspicious findings visible only at MRI, with potential influence on therapeutic decision. The aim of this retrospective study was to evaluate our initial clinical experience with MRI-guided vacuum-assisted breast biopsy as an alternative to surgical excision and to investigate the outcome of MRI-guided breast biopsy as a function of the MRI features of the lesions. PATIENTS AND METHODS.: In 14 women (median age 51 years) with 14 MRI-detected lesions, MRI-guided vacuum-assisted breast biopsy was performed. We evaluated the MRI findings that led to biopsy and we investigated the core and postoperative histology results and follow-up data. RESULTS The biopsy was technically successful in 14 (93%) of 15 women. Of 14 biopsies in 14 women, core histology revealed 6 malignant (6/14, 43%), 6 benign (6/14, 43%) and 2 high-risk (2/14, 14%) lesions. Among the 6 cancer 3 were invasive and 3 were ductal carcinoma in situ (DCIS). The probability of malignancy in our experience was higher for non-mass lesion type and for washout and plateau kinetics. CONCLUSIONS Our initial experience confirms that MRI-guided vacuum-assisted biopsy is fast, safe and accurate alternative to surgical biopsy for breast lesions detected at MRI only.
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143
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Spiegel TN, Hill KA, Warner E. The attitudes of women with BRCA1 and BRCA2 mutations toward clinical breast examinations and breast self-examinations. J Womens Health (Larchmt) 2012; 18:1019-24. [PMID: 20377375 DOI: 10.1089/jwh.2008.1076] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS In screening studies of women with BRCA mutations, magnetic resonance imaging (MRI) plus mammography has >90% sensitivity for detecting breast cancer, with negligible benefit from the addition of breast self-examination (BSE) or clinical breast examination (CBE). Yet CBE is still frequently recommended, and BSE is encouraged for these women. We sought to determine the attitudes of high-risk women toward CBE and BSE. METHODS Between November 2005 and May 2006, 137 women with BRCA mutations participating in a screening study consisting of annual MRI and mammography plus semiannual CBE were asked to complete a mailed Likert-type questionnaire. RESULTS Of the 94 (67%) respondents, mean age 47 (range 28-67), 94% strongly agreed or agreed that CBE was an important way to detect breast cancer, and almost all believed it provided an important connection to the healthcare team. Only 10% said it increased anxiety. Of the 71 (77%) who performed BSE at least occasionally, 53 thought that regular BSE gave them a sense of control over their own health. Of the 21(23%) who did not practice BSE at all, only 3 did not believe that BSE was helpful, and it made 9 more worried about breast cancer CONCLUSIONS Although CBE adds little to cancer detection rates in women with BRCA mutations screened with MRI, the majority of these women considered CBE to be reassuring and an important means of connecting with the healthcare team. Compliance with BSE was only moderate, but it gave a significant proportion of women a greater sense of control.
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Affiliation(s)
- Tirtza N Spiegel
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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144
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Lowry KP, Lee JM, Kong CY, McMahon PM, Gilmore ME, Cott Chubiz JE, Pisano ED, Gatsonis C, Ryan PD, Ozanne EM, Gazelle GS. Annual screening strategies in BRCA1 and BRCA2 gene mutation carriers: a comparative effectiveness analysis. Cancer 2012; 118:2021-30. [PMID: 21935911 PMCID: PMC3245774 DOI: 10.1002/cncr.26424] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/10/2011] [Accepted: 06/20/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although breast cancer screening with mammography and magnetic resonance imaging (MRI) is recommended for breast cancer-susceptibility gene (BRCA) mutation carriers, there is no current consensus on the optimal screening regimen. METHODS The authors used a computer simulation model to compare 6 annual screening strategies (film mammography [FM], digital mammography [DM], FM and magnetic resonance imaging [MRI] or DM and MRI contemporaneously, and alternating FM/MRI or DM/MRI at 6-month intervals) beginning at ages 25 years, 30 years, 35 years, and 40 years, and 2 strategies of annual MRI with delayed alternating DM/FM versus clinical surveillance alone. Strategies were evaluated without and with mammography-induced breast cancer risk using 2 models of excess relative risk. Input parameters were obtained from the medical literature, publicly available databases, and calibration. RESULTS Without radiation risk effects, alternating DM/MRI starting at age 25 years provided the highest life expectancy (BRCA1, 72.52 years, BRCA2, 77.63 years). When radiation risk was included, a small proportion of diagnosed cancers was attributable to radiation exposure (BRCA1, <2%; BRCA2, <4%). With radiation risk, alternating DM/MRI at age 25 years or annual MRI at age 25 years/delayed alternating DM at age 30 years was the most effective, depending on the radiation risk model used. Alternating DM/MRI starting at age 25 years also produced the highest number of false-positive screens per woman (BRCA1, 4.5 BRCA2, 8.1). CONCLUSIONS Annual MRI at age 25 years/delayed alternating DM at age 30 years is probably the most effective screening strategy in BRCA mutation carriers. Screening benefits, associated risks, and personal acceptance of false-positive results should be considered in choosing the optimal screening strategy for individual women.
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Affiliation(s)
- Kathryn P. Lowry
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Janie M. Lee
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Chung Y. Kong
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Pamela M. McMahon
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael E. Gilmore
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
| | | | - Etta D. Pisano
- Medical University of South Carolina College of Medicine, Charleston, SC
| | | | | | - Elissa M. Ozanne
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - G. Scott Gazelle
- Massachusetts General Hospital, Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard School of Public Health, Boston, MA
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145
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Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, Böhm-Vélez M, Mahoney MC, Evans WP, Larsen LH, Morton MJ, Mendelson EB, Farria DM, Cormack JB, Marques HS, Adams A, Yeh NM, Gabrielli G. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012; 307:1394-404. [PMID: 22474203 PMCID: PMC3891886 DOI: 10.1001/jama.2012.388] [Citation(s) in RCA: 758] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening. OBJECTIVE To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer. DESIGN, SETTING, AND PARTICIPANTS From April 2004-February 2006, 2809 women at 21 sites with elevated cancer risk and dense breasts consented to 3 annual independent screens with mammography and ultrasound in randomized order. After 3 rounds of both screenings, 612 of 703 women who chose to undergo an MRI had complete data. The reference standard was defined as a combination of pathology (biopsy results that showed in situ or infiltrating ductal carcinoma or infiltrating lobular carcinoma in the breast or axillary lymph nodes) and 12-month follow-up. MAIN OUTCOME MEASURES Cancer detection rate (yield), sensitivity, specificity, positive predictive value (PPV3) of biopsies performed and interval cancer rate. RESULTS A total of 2662 women underwent 7473 mammogram and ultrasound screenings, 110 of whom had 111 breast cancer events: 33 detected by mammography only, 32 by ultrasound only, 26 by both, and 9 by MRI after mammography plus ultrasound; 11 were not detected by any imaging screen. Among 4814 incidence screens in the second and third years combined, 75 women were diagnosed with cancer. Supplemental incidence-screening ultrasound identified 3.7 cancers per 1000 screens (95% CI, 2.1-5.8; P < .001). Sensitivity for mammography plus ultrasound was 0.76 (95% CI, 0.65-0.85); specificity, 0.84 (95% CI, 0.83-0.85); and PPV3, 0.16 (95% CI, 0.12-0.21). For mammography alone, sensitivity was 0.52 (95% CI, 0.40-0.64); specificity, 0.91 (95% CI, 0.90-0.92); and PPV3, 0.38 (95% CI, 0.28-0.49; P < .001 all comparisons). Of the MRI participants, 16 women (2.6%) had breast cancer diagnosed. The supplemental yield of MRI was 14.7 per 1000 (95% CI, 3.5-25.9; P = .004). Sensitivity for MRI and mammography plus ultrasound was 1.00 (95% CI, 0.79-1.00); specificity, 0.65 (95% CI, 0.61-0.69); and PPV3, 0.19 (95% CI, 0.11-0.29). For mammography and ultrasound, sensitivity was 0.44 (95% CI, 0.20-0.70, P = .004); specificity 0.84 (95% CI, 0.81-0.87; P < .001); and PPV3, 0.18 (95% CI, 0.08 to 0.34; P = .98). The number of screens needed to detect 1 cancer was 127 (95% CI, 99-167) for mammography; 234 (95% CI, 173-345) for supplemental ultrasound; and 68 (95% CI, 39-286) for MRI after negative mammography and ultrasound results. CONCLUSION The addition of screening ultrasound or MRI to mammography in women at increased risk of breast cancer resulted in not only a higher cancer detection yield but also an increase in false-positive findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00072501.
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Affiliation(s)
- Wendie A Berg
- American College of Radiology Imaging Network, Philadelphia, Pennsylvania, USA.
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146
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Euhus D. Managing the breast in patients who test positive for hereditary breast cancer. Ann Surg Oncol 2012; 19:1738-44. [PMID: 22395981 DOI: 10.1245/s10434-012-2258-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Indexed: 01/21/2023]
Abstract
PURPOSE AND METHODS The patient who tests positive for hereditary breast cancer has several important decisions to make regarding management of the breasts. Before making an informed decision, the physician must first review the screening assessment to make sure that the patient does not harbor an undiagnosed breast malignancy. In the absence of a malignancy, the management options for the breast range from nonoperative surveillance to prophylactic mastectomy to prevent cancer. In the event that a breast malignancy is diagnosed after a positive genetic test, implications for management of both the affected and the unaffected breast must be considered. RESULTS AND DISCUSSION The clinical assessment of the patient who tests positive is discussed. If routine pretest mammograms were negative, should additional diagnostic studies be performed to exclude an undetected/occult malignancy, and if so, what are the roles of magnetic resonance imaging, ultrasonography, digital mammogram, and detection of breast cancer circulating tumor cells? Medical management may include increased surveillance and chemopreventative therapy, including tamoxifen and oral contraceptives. Surgical interventions may be undertaken to reduce risk in people with a genetic susceptibility gene for breast or ovarian cancer; risk-reducing surgical options include mastectomy with or without reconstruction and nipple-sparing techniques. Finally, we discuss management decisions for women who test positive and who are diagnosed with a primary breast cancer, compared to women who have no obvious primary tumor but test positive.
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Affiliation(s)
- David Euhus
- Department of Surgery and Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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147
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Tagliafico A, Tagliafico G, Astengo D, Cavagnetto F, Rosasco R, Rescinito G, Monetti F, Calabrese M. Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software. Eur Radiol 2012; 22:1265-70. [DOI: 10.1007/s00330-012-2380-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/18/2011] [Accepted: 12/07/2011] [Indexed: 10/28/2022]
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148
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Cheng YC, Wu NY, Ko JS, Lin PW, Lin WC, Juang SJ, Tsai TT, Chang CY, Chen JH, Cheng HC. Breast cancers detected by breast MRI screening and ultrasound in asymptomatic Asian women: 8 years of experience in Taiwan. Oncology 2012; 82:98-107. [PMID: 22328009 DOI: 10.1159/000335958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/07/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigated one-stop breast screening combining magnetic resonance imaging (MRI) and ultrasound (US) in asymptomatic Asian women. METHODS 3,586 asymptomatic women (mean age, 45.3 years) were retrospectively analyzed by breast MRI followed by US. US-guided biopsy was performed when the MRI-detected lesion was confirmed by US. When the lesion was not detected on the initial US, a second-look US guided by MRI findings was performed. Then biopsy was done. MRI-positive and US-negative patients were followed up according to MRI lesion size, MRI lesion morphology, and mammographic diagnosis. RESULTS In total, 115 subjects had suspicious malignant lesions and received US-guided biopsy, and 47 malignant lesions, including 35 invasive cancers and 12 carcinoma in situ (CIS) lesions, were diagnosed. More than half (22/35, 63%) of the women with invasive cancer were <50 years of age, and 27 (57.4%) of the 47 cancer cases had early breast cancers. Two invasive cancers (5.7%) and 7 CIS lesions (58.3%) were found at the second-look US. The overall cancer incidence was 1.31% (47/3,586) and increased to 2.2% (78/3,586) if precancerous lesions were included. Subjects aged 41-50 years had the highest incidence of cancer detection (1.97%). Five MRI and US-negative cases had cancers found 1 year after the screening. CONCLUSIONS The results from the one-stop breast screening in this study showed that combining MRI and US is an efficient multimodality tool for screening asymptomatic Asian women in a metropolitan area of Taiwan who had concerns about the diagnosis and radiation of mammography.
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149
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Vázquez Caruncho M. [Women with high risk of breast cancer. More bright spots than shadows and many dark spots]. RADIOLOGIA 2012; 54:462-4. [PMID: 22284560 DOI: 10.1016/j.rx.2011.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/09/2011] [Accepted: 10/13/2011] [Indexed: 10/14/2022]
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150
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Nakano S, Yoshida M, Fujii K, Yorozuya K, Kousaka J, Mouri Y, Fukutomi T, Ohshima Y, Kimura J, Ishiguchi T. Real-time virtual sonography, a coordinated sonography and MRI system that uses magnetic navigation, improves the sonographic identification of enhancing lesions on breast MRI. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:42-49. [PMID: 22137178 DOI: 10.1016/j.ultrasmedbio.2011.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 10/03/2011] [Accepted: 10/09/2011] [Indexed: 05/31/2023]
Abstract
This study verified that recently developed real-time virtual sonography (RVS) to coordinate a sonography image and the magnetic resonance imaging (MRI) multiplanar reconstruction (MPR) with magnetic navigation was useful. The purpose of this study was to evaluate the accuracy of RVS to sonographically identify enhancing lesions by breast MRI. Between December 2008 and May 2009, RVS was performed in 51 consecutive patients with 63 enhancing lesions. MRI was performed with the patients in the supine position using a 1.5-T imager with a body surface coil to achieve the same position as with sonography. To assess the accuracy of the RVS, the following three issues were analyzed: (i) The sonographic detection rate of enhancing lesions, (ii) the comparison of the tumor size measured by sonography and the MRI-MPR and (iii) the positioning errors as the distance from the actual sonographic position to the expected MRI position in 3-D. Among the 63 enhancing lesions, 42 (67%) lesions were identified by conventional B-mode, whereas the remaining 21 (33%) initial conventional B-mode occult lesions were identified by RVS alone. The sonographic size of the lesions detected by RVS alone was significantly smaller than that of lesions detected by conventional B-mode (p < 0.001). The mean tumor size provided by RVS was 12.3 mm for real-time sonography and 14.1 mm for MRI-MPR (r = 0.848, p < 0.001). The mean positioning errors for the transverse and sagittal planes and the depth from the skin were 7.7, 6.9 and 2.8 mm, respectively. The overall mean 3D positioning error was 12.0 mm. Our results suggest that RVS has good targeting accuracy to directly compare a sonographic image with MRI results without operator dependence.
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Affiliation(s)
- Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Aichi-gun, Aichi, Japan.
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