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Froelich MF, Kaiser CG. Cost-effectiveness of MR-mammography as a solitary imaging technique in women with dense breasts: an economic evaluation of the prospective TK-Study. Eur Radiol 2020; 31:967-974. [PMID: 32856166 PMCID: PMC7813739 DOI: 10.1007/s00330-020-07129-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/09/2020] [Accepted: 07/31/2020] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate the economic implications of our previous study on the use of MR-mammography (MRM) as a solitary imaging tool in women at intermediate risk due to dense breasts. Background In our previous study, we found MRM to be a specific diagnostic tool with high accuracy in patients with dense breasts representing a patient collective at intermediate risk of breast cancer. For this study, we examined whether MRM is an economical alternative. Methods For the determination of outcomes and costs, a decision model based on potential diagnostic results of MRM was developed. Quality of life was estimated in a Markov chain model distinguishing between the absence of malignancy, the presence of malignancy, and death. Input parameters were utilized from the prospective TK-Study. To investigate the economic impact of MRM, overall costs in € and outcomes of MRM in quality-adjusted life years (QALYs) were estimated. A deterministic sensitivity analysis was performed. Results MRM was associated with expected costs of 1650.48 € in the 5-year period and an expected cumulative outcome of 4.69 QALYs. A true positive diagnosis resulted in significantly lower costs and a higher quality of life when compared to the consequences of a false negative result. In the deterministic sensitivity analysis, treatment costs had more impact on overall costs than the costs of MRM. The total costs per patient remained below 2500 € in the 5-year period. Conclusion MRM, as a solitary imaging tool in patients at intermediate risk due to dense breasts, is economically feasible. Key Points • In patients with dense breasts (i.e., patients at intermediate risk of breast cancer), the relative cost of MR-mammography examinations only had moderate impact on overall costs. • This is due to cost-savings through the application of a sensitive imaging technique resulting in an optimized staging and therapy planning. • MR-mammography, unaccompanied by mammography or ultrasound in patients with dense breasts, was economically feasible in our analysis.
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Affiliation(s)
- Matthias F Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim - University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Clemens G Kaiser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim - University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Ucar EA, Durur-Subasi I, Yilmaz KB, Arikok AT, Hekimoglu B. Quantitative perfusion parameters of benign inflammatory breast pathologies: A descriptive study. Clin Imaging 2020; 68:249-256. [PMID: 32911313 DOI: 10.1016/j.clinimag.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE With this study, we evaluated the perfusion magnetic resonance imaging (MRI) features of benign inflammatory breast lesions for the first time and compared their Ktrans, Kep, Ve values and contrast kinetic curves to benign masses and invasive ductal carcinoma (IDC). MATERIALS AND METHODS Perfusion MRIs of the benign masses (n = 42), inflammatory lesions (n = 25), and IDCs (n = 16) were evaluated retrospectively in terms of Ktrans, Kep, Ve values and contrast kinetic curves and compared by the Kruskal-Wallis, Mann-Whitney U, chi-square tests statistically. Cronbach α test was used to measure intraobserver and interobserver reliability. RESULTS Mean Ktrans values were 0.052 for benign masses, 0.086 for inflammatory lesions and 0.101 for IDC (p < 0.001). Mean Kep values were 0.241 for benign masses, 0.435 for inflammatory lesions and 0.530 for IDC (p < 0.001). Mean Ve values were 0.476 for benign masses, 0.318 for inflammatory lesions and 0.310 for IDC (p = 0.067). For inflammatory and IDC lesions, Ktrans and Kep values were found to be higher and Ve values were lower than benign masses (p = 0.001 for Ktrans, p = 0.001 for Kep, p = 0.045 for Ve). There were excellent or good intra-interobserver reliabilities. For the kinetic curve pattern, most of the benign lesions showed progressive (81%), inflammatory lesions progressive (64%) and IDC lesions plateau (75%) patterns (p < 0.001). CONCLUSIONS On T1 perfusion MRI, similar to IDC lesions, inflammatory lesions demonstrate higher Ktrans and Kep and lower Ve values than benign masses. Quantitative perfusion parameters are not helpful in differentiating them from IDC lesions.
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Affiliation(s)
- Elif Ayse Ucar
- Bor Public Hospital, Clinic of Radiology, Nigde, Turkey; University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey.
| | - Irmak Durur-Subasi
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey; Istanbul Medipol University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Kerim Bora Yilmaz
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of General Surgery, Ankara, Turkey
| | - Ata Turker Arikok
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Pathology, Ankara, Turkey
| | - Baki Hekimoglu
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey
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153
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Amin AL, Sack S, Larson KE, Winblad O, Balanoff CR, Nazir N, Wagner JL. Does the Addition of Breast MRI Add Value to the Diagnostic Workup of Invasive Lobular Carcinoma? J Surg Res 2020; 257:144-152. [PMID: 32828998 DOI: 10.1016/j.jss.2020.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) has unique histologic growth pattern. Few studies have focused on the value of breast magnetic resonance imaging (MRI) specifically for ILC. We hypothesized that MRI adds value to the diagnostic workup in ILC by better defining the extent of disease and identifying additional foci of malignancy, which can change the surgical plan. MATERIALS AND METHODS This was a single-institution retrospective review of women diagnosed with ILC from 1/2012 to 7/2019 who underwent preoperative MRI. Patient, tumor characteristics, and initial surgical plan were reviewed. MRI had added value if ILC size correlated best to final pathologic size or if additional malignancy was identified. MRI was considered harmful if additional biopsies were benign or if the size was overestimated. RESULTS ILC was identified in 166 breasts in 165 women. Original surgical plan was for lumpectomy in 86 (52%), mastectomy in 49 (30%), and undecided in 31 (18%). MRI changed the plan in 25 (19%) with 24 (96%) changing from lumpectomy to mastectomy. Additional biopsy was performed in 28% after MRI, the majority (n = 41, 72%) were benign or high risk and 16 (28%) identified additional malignancy. MRI was not a better size estimate than mammogram/ultrasound. Re-excision rate after lumpectomy was 6.8% (5/73). MRI added value in 48 (28.9%) and was harmful in 48 (28.9%). CONCLUSIONS Using breast MRI in the diagnostic workup of ILC has both positive and negative implications on surgical treatment planning. A shared decision-making conversation is warranted before proceeding with MRI to maximize value and minimize harms associated with this diagnostic tool.
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Affiliation(s)
- Amanda L Amin
- Department of Surgery, The University of Kansas Health System, Kansas City, Kansas.
| | - Stephen Sack
- Department of Surgery, The University of Kansas Health System, Kansas City, Kansas
| | - Kelsey E Larson
- Department of Surgery, The University of Kansas Health System, Kansas City, Kansas
| | - Onalisa Winblad
- Department of Radiology, The University of Kansas Health System, Kansas City, Kansas
| | - Christa R Balanoff
- Department of Surgery, The University of Kansas Health System, Kansas City, Kansas
| | - Niaman Nazir
- Department of Population Health, The University of Kansas Health System, Kansas City, Kansas
| | - Jamie L Wagner
- Department of Surgery, The University of Kansas Health System, Kansas City, Kansas
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Breast Implant Imaging Surveillance among U.S. Plastic Surgeons: U.S. Food and Drug Administration Recommendations versus Clinical Reality. Plast Reconstr Surg 2020; 145:1381-1387. [PMID: 32459768 DOI: 10.1097/prs.0000000000006812] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Device rupture is considered a major complication associated with breast implants. The U.S. Food and Drug Administration recommends magnetic resonance imaging (MRI) surveillance 3 years after implantation and then every 2 years, but adherence to these recommendations is poor. The authors identified current practice management for breast implant rupture surveillance by surveying practicing U.S. plastic surgeons. METHODS An online survey of all active members of the American Society of Plastic Surgeons was performed. Questions analyzed imaging practice patterns related to breast implants. Logistic regression models were used to analyze determinants for radiographic imaging in breast implant patients. RESULTS The survey had a response rate of 16.5 percent. For patients with breast implants, 37.7 percent of respondents recommended MRI at the recommended intervals. Fifty-five percent perform imaging only if there is a problem with the implant. Academic surgeons more frequently recommended MRI (56.3 percent and 39.3 percent; p = 0.0002). Surgeons with less than 5 years of experience are four times more likely to order MRI than surgeons with over 25 years' experience (60.8 percent and 28.1 percent; p < 0.0001). Furthermore, lower volume surgeons recommend significantly more MRI (45.2 percent and 27.3 percent; p = 0.001). Respondents are almost two times more likely to recommend MRI in reconstructive versus cosmetic patients (51.2 percent and 35.6 percent; p = 0.0004). CONCLUSIONS MRI limitations include high costs, time commitments, and equipment constraints. Fewer than 40 percent of survey respondents suggest the recommended screening frequency to their patients; however, academic, low-volume, early-career surgeons are more likely to recommend MRI implant monitoring. Screening recommendations need to be evidence based and align with common practices to prevent undue system, provider, and patient burden.
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Radiomics for Tumor Characterization in Breast Cancer Patients: A Feasibility Study Comparing Contrast-Enhanced Mammography and Magnetic Resonance Imaging. Diagnostics (Basel) 2020; 10:diagnostics10070492. [PMID: 32708512 PMCID: PMC7400681 DOI: 10.3390/diagnostics10070492] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 01/01/2023] Open
Abstract
The aim of our intra-individual comparison study was to investigate and compare the potential of radiomics analysis of contrast-enhanced mammography (CEM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast for the non-invasive assessment of tumor invasiveness, hormone receptor status, and tumor grade in patients with primary breast cancer. This retrospective study included 48 female patients with 49 biopsy-proven breast cancers who underwent pretreatment breast CEM and MRI. Radiomics analysis was performed by using MaZda software. Radiomics parameters were correlated with tumor histology (invasive vs. non-invasive), hormonal status (HR+ vs. HR-), and grading (low grade G1 + G2 vs. high grade G3). CEM radiomics analysis yielded classification accuracies of up to 92% for invasive vs. non-invasive breast cancers, 95.6% for HR+ vs. HR- breast cancers, and 77.8% for G1 + G2 vs. G3 invasive cancers. MRI radiomics analysis yielded classification accuracies of up to 90% for invasive vs. non-invasive breast cancers, 82.6% for HR+ vs. HR- breast cancers, and 77.8% for G1+G2 vs. G3 cancers. Preliminary results indicate a potential of both radiomics analysis of DCE-MRI and CEM for non-invasive assessment of tumor-invasiveness, hormone receptor status, and tumor grade. CEM may serve as an alternative to MRI if MRI is not available or contraindicated.
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156
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Meucci R, Pistolese Chiara A, Perretta T, Vanni G, Portarena I, Manenti G, Ryan Colleen P, Castrignanò A, Di Stefano C, Ferrari D, Lamacchia F, Pellicciaro M, Materazzo M, Buonomo Oreste C. MR imaging-guided vacuum assisted breast biopsy: Radiological-pathological correlation and underestimation rate in pre-surgical assessment. Eur J Radiol Open 2020; 7:100244. [PMID: 32715029 PMCID: PMC7369605 DOI: 10.1016/j.ejro.2020.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Magnetic Resonance(MR) guided percutaneous procedures(MRgVABB) have been developed and largely employed to reduce the need of surgical biopsies for suspicious lesions which can be detected only by MR(MR-only lesion). The present study aims to investigate correlation between imaging, histological features of MRgVABB and surgical specimens of MR-only lesions. METHODS We retrospectively enrolled 56 patients with a total of 61 lesions. Each finding was defined as Mass-Enhancement(ME) or Non-ME(NME) and classified according to BI-RADS. MRgVABB and surgical data were collected. Concordance between MR, MRgVABB and open biopsy was calculated. Underestimation Rate(UR) of MRgVABB with surgery was obtained. RESULTS B2 and B5b lesions were statistically associated with NME and ME, respectively. No statistical association was found to B3 nor to B5a with radiological features. UR was 10 %; underestimated lesions were strongly associated with the presence of a ME on MR imaging. Moreover, B3 lesions are associated with higher UR. CONCLUSION Radiological features should influence patient management aiming to construct a correct diagnostic and therapeutic plan. When MR is prescribed for breast cancer staging for ME-MR-only lesions, we suggest surgical open biopsy instead of MRgVABB when upfront surgery is the treatment of choice.
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Affiliation(s)
- Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Adriana Pistolese Chiara
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Patricia Ryan Colleen
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Antonella Castrignanò
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Donatella Ferrari
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
| | - Claudio Buonomo Oreste
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata(PTV) University, Viale Oxford 81, 00133, Rome, Italy
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Rahbar H, Hippe DS, Alaa A, Cheeney SH, van der Schaar M, Partridge SC, Lee CI. The Value of Patient and Tumor Factors in Predicting Preoperative Breast MRI Outcomes. Radiol Imaging Cancer 2020; 2:e190099. [PMID: 32803166 DOI: 10.1148/rycan.2020190099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/12/2020] [Accepted: 03/16/2020] [Indexed: 12/17/2022]
Abstract
Purpose To identify patient and tumor features that predict true-positive, false-positive, and negative breast preoperative MRI outcomes. Materials and Methods Using a breast MRI database from a large regional cancer center, the authors retrospectively identified all women with unilateral breast cancer who underwent preoperative MRI from January 2005 to February 2015. A total of 1396 women with complete data were included. Patient features (ie, age, breast density) and index tumor features (ie, type, grade, hormone receptor, human epidermal growth factor receptor type 2/neu, Ki-67) were extracted and compared with preoperative MRI outcomes (ie, true positive, false positive, negative) using univariate (ie, Fisher exact) and multivariate machine learning approaches (ie, least absolute shrinkage and selection operator, AutoPrognosis). Overall prediction performance was summarized using the area under the receiver operating characteristic curve (AUC), calculated using internal validation techniques (bootstrap and cross-validation) to account for model training. Results At the examination level, 181 additional cancers were identified among 1396 total preoperative MRI examinations (median patient age, 56 years; range, 25-94 years), resulting in a positive predictive value for biopsy of 43% (181 true-positive findings of 419 core-needle biopsies). In univariate analysis, no patient or tumor feature was associated with a true-positive outcome (P > .05), although greater mammographic density (P = .022) and younger age (< 50 years, P = .025) were associated with false-positive examinations. Machine learning approaches provided weak performance for predicting true-positive, false-positive, and negative examinations (AUC range, 0.50-0.57). Conclusion Commonly used patient and tumor factors driving expert opinion for the use of preoperative MRI provide limited predictive value for determining preoperative MRI outcomes in women. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Grimm in this issue.
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Affiliation(s)
- Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
| | - Ahmed Alaa
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
| | - Safia H Cheeney
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
| | - Mihaela van der Schaar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, Room LG2-211, Seattle, WA 98109 (H.R., D.S.H., S.H.C., S.C.P., C.I.L.); Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, Calif (A.A., M.v.d.S.); and Departments of Applied Mathematics and Theoretical Physics and Public Health, University of Cambridge, Cambridge, England (M.v.d.S.)
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Reyes E, Xercavins N, Saura C, Espinosa-Bravo M, Gil-Moreno A, Cordoba O. Breast cancer during pregnancy: matched study of diagnostic approach, tumor characteristics, and prognostic factors. TUMORI JOURNAL 2020; 106:378-387. [PMID: 32623975 DOI: 10.1177/0300891620925158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Breast cancer is one of the most frequently occurring cancers during pregnancy and its incidence is increasing. Many studies have shown poor outcomes, the causes of which remain unclear. OBJECTIVES To analyze radiologic characteristics, histology, and prognosis factors of breast cancer during pregnancy. METHODS A total of 42 patients with breast cancer diagnosed during pregnancy (BCP) were matched with 84 patients with breast cancer of similar age who were not pregnant. Sensitivity of radiology, tumor characteristics, prognosis factors, disease-free survival, and overall survival were analyzed. RESULTS The sensitivity of breast ultrasound was higher than that of mammography for both groups. Ultrasound sensitivity for cancer was 95.7% in patients with BCP versus 98% in the not pregnant group, with non-statistically significant differences. Mammography sensitivity for cancer was 56.5% in patients with BCP versus 61% in the not pregnant group, with non-statistically significant differences. The stage at diagnosis according to the TNM staging system was significantly higher in patients with BCP with stage IV cancer: 16.7% in patients with BCP versus 3.7% in the not pregnant group (p = 0.03). No statistically significant differences were observed in histologic grade, Ki-67 index, or molecular subtype. Disease-free survival and overall survival were significantly lower in patients with BCP (p = 0.002 and p = 0.04). Multivariate analysis showed no difference when adjusting for stage and surrogate molecular subtype. CONCLUSION Breast ultrasound shows a high sensitivity to detect breast cancer during pregnancy. BCP is diagnosed at a higher stage than in nonpregnant women. In our series, patients with BCP had poorer outcomes than the not pregnant group. These results were not observed when adjusting for stage.
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Affiliation(s)
- Eduardo Reyes
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Natalia Xercavins
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Saura
- Vall d'Hebron Breast Cancer Center, Service of Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Martin Espinosa-Bravo
- Vall d'Hebron Breast Cancer Center, Service of Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Gil-Moreno
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Octavi Cordoba
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
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Alonso Roca S, Delgado Laguna A, Arantzeta Lexarreta J, Cajal Campo B, Santamaría Jareño S. Screening in patients with increased risk of breast cancer (part 1): Pros and cons of MRI screening. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Development of MRI Projection Mapping System for Breast-Conserving Surgery in the Operating Room: Preliminary Clinical Results in Invasive Breast Cancer. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5314120. [PMID: 32685501 PMCID: PMC7341375 DOI: 10.1155/2020/5314120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
Aim To evaluate the feasibility of a newly developed prototype MRI projection mapping (PM) system for localization of invasive breast cancer before breast-conserving surgery. Methods This prospective study enrolled 10 women with invasive breast cancer. MRI was performed in both prone and supine positions. The tumor location was drawn on the breast skin using palpation and sonography while referring to the prone MRI (i.e., a conventional method). A maximum intensity projection image generated from the supine MRI was projected using our PM system, and the tumor location was drawn. The PM system consisted of a projector and a camera and was used to measure the shape of the breast surface using the structured light method. Breast-conserving surgery was performed based on the conventional method. We compared the tumor size and location between the PM and conventional methods or pathology. Results There were no significant differences in the maximum diameters of invasive cancers between the PM system and the conventional method or pathology. The maximum discrepancy in tumor location between the PM and conventional method was 3–8 mm. Conclusions This PM system may support breast-conserving surgery by showing the tumor size and location on the breast surface.
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161
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Okuma H, Sudah M, Kettunen T, Niukkanen A, Sutela A, Masarwah A, Kosma VM, Auvinen P, Mannermaa A, Vanninen R. Peritumor to tumor apparent diffusion coefficient ratio is associated with biologically more aggressive breast cancer features and correlates with the prognostication tools. PLoS One 2020; 15:e0235278. [PMID: 32584887 PMCID: PMC7316248 DOI: 10.1371/journal.pone.0235278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The apparent diffusion coefficient (ADC) is increasingly used to characterize breast cancer. The peritumor/tumor ADC ratio is suggested to be a reliable and generally applicable index. However, its overall prognostication value remains unclear. We aimed to evaluate the associations between the peritumor/tumor ADC ratio and histopathological biomarkers and published prognostic tools in patients with invasive breast cancer. MATERIALS AND METHODS This prospective study included 88 lesions (five bilateral) in 83 patients with primary invasive breast cancer who underwent preoperative 3.0-T magnetic resonance imaging. The lowest intratumoral mean ADC value on the slice with the largest tumor cross-sectional area was designated the tumor ADC, and the highest mean ADC value on the peritumoral breast parenchymal tissue adjacent to the tumor border was designated the peritumor ADC. The peritumor/tumor ADC ratio was then calculated. The tumor and peritumor ADC values and peritumor/tumor ADC ratios were compared with histopathological parameters using an unpaired t test, and their correlations with published prognostic tools were evaluated with Pearson's correlation coefficient. RESULTS The peritumor/tumor ADC ratio was significantly associated with tumor size (p<0.001), histological grade (p = 0.005), Ki-67 index (p = 0.006), axillary-lymph-node metastasis (p = 0.001), and lymphovascular invasion (p = 0.006), but was not associated with estrogen receptor status (p = 0.931), progesterone receptor status (p = 0.160), or human epidermal growth factor receptor 2 status (p = 0.259). The peritumor/tumor ADC ratio showed moderate positive correlations with the Nottingham Prognostic Index (r = 0.498, p<0.001) and mortality predicted using PREDICT (r = 0.436, p<0.001). CONCLUSION The peritumor/tumor ADC ratio was correlated with histopathological biomarkers in patients with invasive breast cancer, showed significant correlations with published prognostic indexes, and may provide an easily applicable imaging index for the preoperative prognostic evaluation of breast cancer.
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Affiliation(s)
- Hidemi Okuma
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
| | - Mazen Sudah
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiia Kettunen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Anton Niukkanen
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Amro Masarwah
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Veli-Matti Kosma
- Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, and Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Auvinen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Arto Mannermaa
- Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, and Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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162
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Sindi R, Wong YH, Yeong CH, Sun Z. Development of patient-specific 3D-printed breast phantom using silicone and peanut oils for magnetic resonance imaging. Quant Imaging Med Surg 2020; 10:1237-1248. [PMID: 32550133 DOI: 10.21037/qims-20-251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Despite increasing reports of 3D printing in medical applications, the use of 3D printing in breast imaging is limited, thus, personalized 3D-printed breast model could be a novel approach to overcome current limitations in utilizing breast magnetic resonance imaging (MRI) for quantitative assessment of breast density. The aim of this study is to develop a patient-specific 3D-printed breast phantom and to identify the most appropriate materials for simulating the MR imaging characteristics of fibroglandular and adipose tissues. Methods A patient-specific 3D-printed breast model was generated using 3D-printing techniques for the construction of the hollow skin and fibroglandular region shells. Then, the T1 relaxation times of the five selected materials (agarose gel, silicone rubber with/without fish oil, silicone oil, and peanut oil) were measured on a 3T MRI system to determine the appropriate ones to represent the MR imaging characteristics of fibroglandular and adipose tissues. Results were then compared to the reference values of T1 relaxation times of the corresponding tissues: 1,324.42±167.63 and 449.27±26.09 ms, respectively. Finally, the materials that matched the T1 relaxation times of the respective tissues were used to fill the 3D-printed hollow breast shells. Results The silicone and peanut oils were found to closely resemble the T1 relaxation times and imaging characteristics of these two tissues, which are 1,515.8±105.5 and 405.4±15.1 ms, respectively. The agarose gel with different concentrations, ranging from 0.5 to 2.5 wt%, was found to have the longest T1 relaxation times. Conclusions A patient-specific 3D-printed breast phantom was successfully designed and constructed using silicone and peanut oils to simulate the MR imaging characteristics of fibroglandular and adipose tissues. The phantom can be used to investigate different MR breast imaging protocols for the quantitative assessment of breast density.
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Affiliation(s)
- Rooa Sindi
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, WA, Australia.,Radio-diagnostic and Medical Imaging Department, Medical Physics Section, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Yin How Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, WA, Australia
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, López Ruiz A. Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020; 62:417-433. [PMID: 32527577 DOI: 10.1016/j.rx.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 03/12/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening. In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies», such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery.The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies» in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A López Ruiz
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, Zackrisson S, Senkus E. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2020; 30:1194-1220. [PMID: 31161190 DOI: 10.1093/annonc/mdz173] [Citation(s) in RCA: 1101] [Impact Index Per Article: 275.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | | | - S Ohno
- Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - F Penault-Llorca
- Department of Pathology, Centre Jean Perrin, Clermont-Ferrand; .,UMR INSERM 1240, IMoST Université d'Auvergne, Clermont-Ferrand
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie, Paris;,Paris Sciences & Lettres – PSL University, Paris, France
| | - I T Rubio
- Breast Surgical Oncology Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - S Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University and Skåne University Hospital Malmö, Malmö, Sweden
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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165
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Zhang J, Tan X, Zhang X, Kang Y, Li J, Ren W, Ma Y. Efficacy of shear-wave elastography versus dynamic optical breast imaging for predicting the pathological response to neoadjuvant chemotherapy in breast cancer. Eur J Radiol 2020; 129:109098. [PMID: 32559591 DOI: 10.1016/j.ejrad.2020.109098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Explore the value of shear-wave elastography (SWE) parameters and dynamic optical breast imaging features for predicting pathological responses to neoadjuvant chemotherapy (NACT) in breast cancer (BC). METHOD This prospective cohort study included 91 BC patients receiving NACT. Tumor size, SWE (maximum stiffness [Emax] and mean stiffness [Emean]), blood score (BS), and oxygen score (OS) and their relative changes were collected before (t0), during (t1-t5), and after NACT (t6). The pathological response was classified according to the residual cancer burden. Relationships between tumor size, SWE stiffness, BS, and OS at t0-t6 were analyzed, and their predictive power was compared. RESULTS During six NACT cycles, tumor size, tumor stiffness, and BS decreased, and tumor OS increased. ΔEmean (t2), E2mean, BS2, and OS2 had a greater power than other indexes for predicting a favorable response (AUC = 0.79, 0.71, 0.77, 0.78) and a resistance response (0.86, 0.74, 0.71, 0.71). For the favorable response, predictive power did not differ significantly between ΔEmean (t2), E2mean, BS2, and OS2, whereas for the resistance response, ΔEmean (t2) showed better prediction than E2mean, BS2, and OS2. CONCLUSIONS SWE stiffness, BS, and OS exhibited good and similar performances in predicting a NACT favorable response, and SWE stiffness showed better performance than BS and OS in predicting NACT resistance. These results may provide an important reference for individualized treatment in BC patients receiving NACT.
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Affiliation(s)
- Jing Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Xintong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Jianyi Li
- Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
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166
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Ha SM, Chang JM, Lee SH, Kim ES, Kim SY, Cho N, Moon WK. Diffusion-weighted MRI at 3.0 T for detection of occult disease in the contralateral breast in women with newly diagnosed breast cancer. Breast Cancer Res Treat 2020; 182:283-297. [PMID: 32447596 DOI: 10.1007/s10549-020-05697-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Diffusion-weighted magnetic resonance imaging (DW-MRI) offers unenhanced method to detect breast cancer without cost and safety concerns associated with dynamic contrast-enhanced (DCE) MRI. Our purpose was to evaluate the performance of DW-MRI at 3.0T in detection of clinically and mammographically occult contralateral breast cancer in patients with unilateral breast cancer. METHODS Between 2017 and 2018, 1130 patients (mean age 53.3 years; range 26-84 years) with newly diagnosed unilateral breast cancer who underwent breast MRI and had no abnormalities on clinical and mammographic examinations of contralateral breast were included. Three experienced radiologists independently reviewed DW-MRI (b = 0 and 1000 s/mm2) and DCE-MRI and assigned a BI-RADS category. Using histopathology or 1-year clinical follow-up, performance measures of DW-MRI were compared with DCE-MRI. RESULTS A total of 21 (1.9%, 21/1130) cancers were identified (12 ductal carcinoma in situ and 9 invasive ductal carcinoma; mean invasive tumor size, 8.0 mm) in the contralateral breast. Cancer detection rate of DW-MRI was 13-15 with mean of 14 per 1000 examinations (95% confidence interval [CI] 9-23 per 1000 examinations), which was lower than that of DCE-MRI (18-19 with mean of 18 per 1000 examinations, P = 0.01). A lower abnormal interpretation rate (14.0% versus 17.0%, respectively, P < 0.001) with higher specificity (87.3% versus 84.6%, respectively, P < 0.001) but lower sensitivity (77.8% versus 96.8%, respectively, P < 0.001) was noted for DW-MRI compared to DCE-MRI. CONCLUSIONS DW-MRI at 3.0T has the potential as a cost-effective tool for evaluation of contralateral breast in women with newly diagnosed breast cancer.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Eun Sil Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
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Ma X, Wang J, Zheng X, Liu Z, Long W, Zhang Y, Wei J, Lu Y. Automated fibroglandular tissue segmentation in breast MRI using generative adversarial networks. Phys Med Biol 2020; 65:105006. [PMID: 32155611 DOI: 10.1088/1361-6560/ab7e7f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fibroglandular tissue (FGT) segmentation is a crucial step for quantitative analysis of background parenchymal enhancement (BPE) in magnetic resonance imaging (MRI), which is useful for breast cancer risk assessment. In this study, we develop an automated deep learning method based on a generative adversarial network (GAN) to identify the FGT region in MRI volumes and evaluate its impact on a specific clinical application. The GAN consists of an improved U-Net as a generator to generate FGT candidate areas and a patch deep convolutional neural network (DCNN) as a discriminator to evaluate the authenticity of the synthetic FGT region. The proposed method has two improvements compared to the classical U-Net: (1) the improved U-Net is designed to extract more features of the FGT region for a more accurate description of the FGT region; (2) a patch DCNN is designed for discriminating the authenticity of the FGT region generated by the improved U-Net, which makes the segmentation result more stable and accurate. A dataset of 100 three-dimensional (3D) bilateral breast MRI scans from 100 patients (aged 22-78 years) was used in this study with Institutional Review Board (IRB) approval. 3D hand-segmented FGT areas for all breasts were provided as a reference standard. Five-fold cross-validation was used in training and testing of the models. The Dice similarity coefficient (DSC) and Jaccard index (JI) values were evaluated to measure the segmentation accuracy. The previous method using classical U-Net was used as a baseline in this study. In the five partitions of the cross-validation set, the GAN achieved DSC and JI values of 87.0 ± 7.0% and 77.6 ± 10.1%, respectively, while the corresponding values obtained through by the baseline method were 81.1 ± 8.7% and 69.0 ± 11.3%, respectively. The proposed method is significantly superior to the previous method using U-Net. The FGT segmentation impacted the BPE quantification application in the following manner: the correlation coefficients between the quantified BPE value and BI-RADS BPE categories provided by the radiologist were 0.46 ± 0.15 (best: 0.63) based on GAN segmented FGT areas, while the corresponding correlation coefficients were 0.41 ± 0.16 (best: 0.60) based on baseline U-Net segmented FGT areas. BPE can be quantified better using the FGT areas segmented by the proposed GAN model than using the FGT areas segmented by the baseline U-Net.
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Affiliation(s)
- Xiangyuan Ma
- School of Data and Computer Science, Sun Yat-Sen University, Guangzhou, People's Republic of China. Guangdong Province Key Laboratory Computational Science, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Zhou SC, Le J, Zhou J, Huang YX, Qian L, Chang C. The Role of Contrast-Enhanced Ultrasound in the Diagnosis and Pathologic Response Prediction in Breast Cancer: A Meta-analysis and Systematic Review. Clin Breast Cancer 2020; 20:e490-e509. [PMID: 32371140 DOI: 10.1016/j.clbc.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the overall performance of contrast-enhanced ultrasound (CEUS) in differentiating between benign and malignant breast lesions and in predicting the pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer (BC). MATERIALS AND METHODS Articles published up to April 2019 were systematically searched in Medline, Web of Science, and China National Knowledge Infrastructure. The sensitivities and specificities across studies, the calculations of positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (OR), and constructed summary receiver operating characteristic curves were determined. Methodologic quality was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Subgroup analyses and metaregression were performed on prespecified study-level characteristics. RESULTS Fifty-one studies involving 4875 patients with 5246 breast lesions and 10 studies involving 462 patients with BC receiving NAC were included. Methodologic quality was relatively high, and no publication bias was detected. The overall sensitivity, specificity, diagnostic OR, LR+, and LR- for CEUS were 0.88 (95% confidence interval [CI], 0.86-0.89), 0.82 (95% CI, 0.80-0.83), 30.55 (95% CI, 21.40-43.62), 4.29 (95% CI, 3.51-5.25), and 0.16 (95% CI, 0.13-0.21), respectively, showing statistical heterogeneity. Multivariable metaregression analysis showed contrast mode to be the most significant source of heterogeneity. The overall sensitivity, specificity, LR+, LR, and diagnostic OR of CEUS imaging in predicting the overall pathologic response to NAC in patients with BC were 0.89 (95% CI, 0.83-0.93), 0.83 (95% CI, 0.78-0.88), 4.49 (95% CI, 3.04-6.62), 0.16 (95% CI, 0.10-0.24,), and 32.21 (95% CI, 16.74-62.01), respectively, showing mild heterogeneity. CONCLUSION Our data confirmed the excellent performance of breast CEUS in differentiating between benign and malignant breast lesions as well as pathologic response prediction in patients with BC receiving NAC.
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Affiliation(s)
- Shi-Chong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Le
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Xia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lang Qian
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Solving the preoperative breast MRI conundrum: design and protocol of the MIPA study. Eur Radiol 2020; 30:5427-5436. [PMID: 32377813 DOI: 10.1007/s00330-020-06824-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023]
Abstract
Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.
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170
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Pinker K. Preoperative MRI Improves Surgical Planning and Outcomes for Ductal Carcinoma in Situ. Radiology 2020; 295:304-306. [PMID: 32186457 PMCID: PMC7192566 DOI: 10.1148/radiol.2020200076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Katja Pinker
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Sanderink WBG, Caballo M, Strobbe LJA, Bult P, Vreuls W, Venderink DJ, Sechopoulos I, Karssemeijer N, Mann RM. Reliability of MRI tumor size measurements for minimal invasive treatment selection in small breast cancers. Eur J Surg Oncol 2020; 46:1463-1470. [PMID: 32536526 DOI: 10.1016/j.ejso.2020.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/06/2020] [Accepted: 04/19/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Due to the shift towards minimal invasive treatment, accurate tumor size estimation is essential for small breast cancers. The purpose of this study was to determine the reliability of MRI-based tumor size measurements with respect to clinical, histological and radiomics characteristics in small invasive or in situ carcinomas of the breast to select patients for minimal invasive therapy. MATERIALS AND METHODS All consecutive cases of cT1 invasive breast carcinomas that underwent pre-operative MRI, treated in two hospitals between 2005 and 2016, were identified retrospectively from the Dutch cancer registry and cross-correlated with local databases. Concordance between MRI-based measurements and final pathological size was analyzed. The influence of clinical, histological and radiomics characteristics on the accuracy of MRI size measurements were analyzed. RESULTS Analysis included 343 cT1 breast carcinomas in 336 patients (mean age, 55 years; range, 25-81 years). Overall correlation of MRI measurements with pathology was moderately strong (ρ = 0.530, P < 0.001), in 42 cases (12.2%) MRI underestimated the size with more than 5 mm. Underestimation occurs more often in grade 2 and grade 3 disease than in low grade invasive cancers. In DCIS the frequency of underestimation is higher than in invasive breast cancer. Unfortunately, none of the patient, imaging or biopsy characteristics appeared predictive for underestimation. CONCLUSION Size measurements of small breast cancers on breast MRI are within 5 mm of pathological size in 88% of patients. Nevertheless, underestimation cannot be adequately predicted, particularly for grade 2 and grade 3 tumors, which may hinder patient selection for minimal invasive therapy.
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Affiliation(s)
- W B G Sanderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M Caballo
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - P Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - D J Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - I Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
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172
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Kolta M, Clauser P, Kapetas P, Bernathova M, Pinker K, Helbich TH, Baltzer PAT. Can second-look ultrasound downgrade MRI-detected lesions? A retrospective study. Eur J Radiol 2020; 127:108976. [PMID: 32339982 DOI: 10.1016/j.ejrad.2020.108976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether MRI-detected suspicious (BIRADS 4 & 5) breast lesions can be downgraded using second-look ultrasound (SLU) and thus reduce unnecessarily performed breast biopsies. MATERIALS METHODS A retrospective single-center review of consecutive patients, who underwent breast MRI studies during a 12-month time period was performed. 94 patients with 103 lesions undergoing SLU of incidentally detected MRI BI-RADS 4&5 lesions which were not identified on previous ultrasound were included in the study. The SLU detection rate and SLU features of the lesions were assessed. Histology (91/103) or two year follow up (n = 12) were defined as the reference standard for lesion diagnosis. RESULTS 57 (55.3 %) of the 103 lesions were identified on SLU. 17 of the identified lesions were malignant (29.8 %). Lesions detected on ultrasound presented on MRI as masses in 66.7 % (38/57) and non-mass in 33.3 % (19/57). Our findings showed that it is possible to distinguish between malignant and benign lesions with SLU. The results were significant (p < 0.05) for the following morphological features: shape, orientation, margins, architectural distortion, hyperechoic rim/ edema. All lesions classified as SLU BI-RADS 2 in our study were benign and thus, 30 % of all unnecessary biopsies could potentially have been avoided. Including SLU BI-RADS 3 lesions, this rate increased to 60 %, while yielding one (of 17, 5.8 %) false negative result. All three BI-RADS 5 lesions detected by SLU presented as malignant on ultrasound. CONCLUSION SLU can potentially downgrade incidental MRI BIRADS 4 lesions. This may reduce the number of unnecessarily performed biopsies by 30-60 %, thus simplifying patient management.
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Affiliation(s)
- Michael Kolta
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria; Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, General and Pediatric Radiology, Allgemeines Krankenhaus, Medical University of Vienna, Austria.
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173
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, Santamaría Jareño S. Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening. RADIOLOGIA 2020; 62:252-265. [PMID: 32241593 DOI: 10.1016/j.rx.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 12/23/2019] [Accepted: 01/30/2020] [Indexed: 12/31/2022]
Abstract
Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - S Santamaría Jareño
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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174
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Muscle mass loss after neoadjuvant chemotherapy in breast cancer: estimation on breast magnetic resonance imaging using pectoralis muscle area. Eur Radiol 2020; 30:4234-4241. [PMID: 32232787 DOI: 10.1007/s00330-020-06799-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/21/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The loss of skeletal muscle mass is widely considered a predictor of poor survival and toxicity in breast cancer patients. The aim of this study is to evaluate if there is pectoralis muscle area (PMA) variation, reflecting loss of skeletal muscle mass, on consecutive MRI examinations after neoadjuvant chemotherapy. METHODS The retrospective study protocol was approved by our institutional review board. A total of n = 110 consecutive patients (mean age 56 ± 11 years) who were treated with neoadjuvant chemotherapy (NAC) for histologically proven primary breast cancer between January 2017 and January 2019 and in whom tumor response was checked with standard breast MRI were included. Two radiologists calculated the pectoralis muscle cross-sectional area before and after NAC. RESULTS Time between the MRI examinations, before starting NAC and after completing NAC, was 166.8 ± 50 days. PMA calculated pre-NAC (8.14 cm2) was larger than PMA calculated post-NAC (7.03 cm2) (p < 0.001). According to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, there were no significant differences between responders (complete or partial response) and non-responders (p = 0.362). The multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI exams, estrogen and progesterone receptor status, human epidermal growth factor receptor status (HER-2), Ki-67 expression, lymph node status, RECIST criteria, histological type, average lesion size, molecular categories, and grade. Inter-reader (k = 0.72) and intra-reader agreement (0.69 and 0.71) in PMA assessment were good. CONCLUSIONS Pectoralis muscle mass varies in breast cancer patients undergoing NAC and this difference can be estimated directly on standard breast MRI. KEY POINTS • Pectoralis muscle area variation reflects loss of skeletal muscle mass. • Pectoralis muscle area on MRI is reduced after NAC. • Pectoralis muscle mass loss seems independent from other variables.
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175
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Samiei S, Smidt ML, Vanwetswinkel S, Engelen SME, Schipper RJ, Lobbes MBI, van Nijnatten TJA. Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer. Eur Radiol 2020; 30:4212-4222. [PMID: 32221685 PMCID: PMC7338810 DOI: 10.1007/s00330-020-06760-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
Objectives To investigate whether breast MRI has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Methods Forty-seven patients were included. All had undergone both breast MRI and dedicated axillary MRI, followed by surgery. All included breast MRI exams had complete field of view (FOV) of the axillary region. First, unenhanced T2-weighted (T2W) and subsequent diffusion-weighted (DW) images of both MRI exams were independently analyzed by two breast radiologists using a confidence scale and compared to histopathology. ADC values were measured by two researchers independently. Diagnostic performance parameters were calculated on a patient-by-patient basis. Results T2W breast MRI had the following diagnostic performance: sensitivity of 50.0% and 62.5%, specificity of 92.3%, PPV of 57.1% and 62.5%, NPV of 90.0% and 92.3%, and AUC of 0.72 for reader 1 and 0.78 for reader 2. T2W dedicated axillary MRI had the following diagnostic performance: sensitivity of 37.5% and 62.5%, specificity of 82.1% and 92.3%, PPV of 44.6% and 50.0%, NPV of 87.8% and 91.4%, and AUC of 0.65 for reader 1 and 0.73 for reader 2. In both evaluations, addition of DW images resulted in comparable diagnostic performance. For both breast MRI and dedicated axillary MRI, there was no significant difference between mean ADC values of benign and malignant lymph nodes. Conclusions T2W breast MRI with complete FOV of the axillary region has comparable diagnostic performance as T2W dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Optimization of T2W breast MRI protocol by including a complete FOV of the axillary region can, therefore, be recommended in clinical practice. Key Points • Breast MRI with complete field of view of the axillary region has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. • Optimization of breast MRI protocol by including a complete field of view of the axillary region is recommended in clinical practice. • For both breast MRI and dedicated axillary MRI, DW imaging (including ADC measurements) is of no added value.
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Affiliation(s)
- Sanaz Samiei
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Sigrid Vanwetswinkel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sanne M E Engelen
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Robert-Jan Schipper
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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176
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MRI-guided vacuum-assisted breast biopsy: experience of a single tertiary referral cancer centre and prospects for the future. Med Oncol 2020; 37:36. [PMID: 32221708 DOI: 10.1007/s12032-020-01358-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/02/2020] [Indexed: 01/11/2023]
Abstract
MRI-guided vacuum-assisted breast biopsy (VABB) is used for suspicious breast cancer (BC) lesions which are detectable only with MRI: because the high sensitivity but limited specificity of breast MRI it is a fundamental tool in breast imaging divisions. We analyse our experience of MRI-guided VABB and critically discuss the potentialities of diffusion-weighted imaging (DWI) and artificial intelligence (AI) in this matter. We retrospectively analysed a population of consecutive women underwent VABB at our tertiary referral BC centre from 01/2011 to 01/2019. Reference standard was histological diagnosis or at least 1-year negative follow-up. McNemar, Mann-Whitney and χ2 tests at 95% level of significance were used as statistical exams. 217 women (mean age = 52, 18-72 years) underwent MRI-guided VABB; 11 were excluded and 208 MRI-guided VABB lesions were performed: 34/208 invasive carcinomas, 32/208 DCIS, 8/208 LCIS, 3/208 high-risk lesions and 131/208 benign lesions were reported. Accuracy of MRI-guided VABB was 97%. The predictive features for malignancy were mass with irregular shape (OR 8.4; 95% CI 0.59-31.6), size of the lesion (OR 4.4; 95% CI 1.69-9.7) and mass with irregular/spiculated margins (OR 5.4; 95% CI 6.8-31.1). Six-month follow-up showed 4 false-negative cases (1.9%). Invasive BC showed a statistically significant higher hyperintense signal at DWI compared to benign lesions (p = 0.03). No major complications occurred. MR-guided VABB showed high accuracy. Benign-concordant lesions should be followed up with breast MRI in 6-12 months due to the risk of false-negative results. DWI and AI applications showed potential benefit as support tools for radiologists.
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177
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Peritumoral edema as a biomarker of the aggressiveness of breast cancer: results of a retrospective study on a 3 T scanner. Breast Cancer Res Treat 2020; 181:53-60. [DOI: 10.1007/s10549-020-05592-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/09/2020] [Indexed: 01/07/2023]
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178
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Wang J, Song Y, Liu J, Meng X, Xing Z, Zhang M, Ye F, Wang X, Wang X. Clinical Application and Feasibility of MRI-Guided Breast Biopsy of Breast Minimal Lesions in Chinese Population. Front Oncol 2020; 10:257. [PMID: 32211320 PMCID: PMC7067823 DOI: 10.3389/fonc.2020.00257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/14/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives: Some breast lesions are not visible on mammography or ultrasonography, and magnetic resonance imaging (MRI) become the only way to monitor these lesions. The purpose of this study was to evaluate the clinical application of MRI-guided biopsy and MRI-guided wire localization of breast minimal lesions in Chinese population. Methods: We evaluated 95 patients (the most patients of known in China) from August 2013 to December 2017. All the patients were scanned with a 1.5-Tesla MRI system (GE Medical Systems, America) in the prone position using a bilateral 8-channel phased-array breast coil and underwent MRI-guided wire localization or MRI-guided biopsy. Results: MRI-guided wire localization and MRI-guided biopsy were successfully performed in 87 patients with 88 lesions (100%, 88/88). After biopsy or surgery, 36 of 88 lesions (40.91%) were malignant, and 52 of 88 lesions (59.09%) were benign. Thirty-nine of 88 lesions (44.32%) were masses, and 49 of 88 (55.68%) showed non-mass enhancement. Statistical analysis showed there was no significant correlation between the malignancy rate and the type of lesion on MRI (P = 0.27). In this study, the rate of malignancy for Breast Imaging-Reporting and Data System (BI-RADS) 5 lesions was 100% (2 of 2) compared with 44.44% for BI-RADS 4C lesions (4 of 9), 42.42% for BI-RADS 4B lesions (14 of 33), and 36.36% for BI-RADS 4A lesions (16 of 44). Conclusions: MRI-guided wire localization with subsequent surgical biopsy and MRI-guided biopsy are safe and effective tools for breast minimal lesions.
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Affiliation(s)
- Jie Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangzhi Meng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeyu Xing
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Menglu Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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179
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Solomon E, Liberman G, Nissan N, Furman‐Haran E, Sklair‐Levy M, Frydman L. Diffusion‐weighted breast MRI of malignancies with submillimeter resolution and immunity to artifacts by spatiotemporal encoding at 3T. Magn Reson Med 2020; 84:1391-1403. [DOI: 10.1002/mrm.28213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Eddy Solomon
- Department of Chemical and Biological Physics Weizmann Institute of Science Rehovot Israel
| | - Gilad Liberman
- Department of Chemical and Biological Physics Weizmann Institute of Science Rehovot Israel
| | - Noam Nissan
- Department of Radiology Sheba‐Medical‐Center Ramat‐Gan Israel
| | - Edna Furman‐Haran
- Life Sciences Core Facilities Weizmann Institute of Science Rehovot Israel
| | - Miri Sklair‐Levy
- Department of Radiology Sheba‐Medical‐Center Ramat‐Gan Israel
- Sackler School of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Lucio Frydman
- Department of Chemical and Biological Physics Weizmann Institute of Science Rehovot Israel
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180
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Sodano C, Clauser P, Dietzel M, Kapetas P, Pinker K, Helbich TH, Gussew A, Baltzer PA. Clinical relevance of total choline (tCho) quantification in suspicious lesions on multiparametric breast MRI. Eur Radiol 2020; 30:3371-3382. [PMID: 32065286 PMCID: PMC7248046 DOI: 10.1007/s00330-020-06678-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/03/2020] [Accepted: 01/27/2020] [Indexed: 12/24/2022]
Abstract
Purpose To assess the additional value of quantitative tCho evaluation to diagnose malignancy and lymph node metastases in suspicious lesions on multiparametric breast MRI (mpMRI, BI-RADS 4, and BI-RADS 5). Methods One hundred twenty-one patients that demonstrated suspicious multiparametric breast MRI lesions using DCE, T2w, and diffusion-weighted (DW) images were prospectively enrolled in this IRB-approved study. All underwent single-voxel proton MR spectroscopy (1H-MRS, point-resolved spectroscopy sequence, TR 2000 ms, TE 272 ms) with and without water suppression. The total choline (tCho) amplitude was measured and normalized to millimoles/liter according to established methodology by two independent readers (R1, R2). ROC-analysis was employed to predict malignancy and lymph node status by tCho results. Results One hundred three patients with 74 malignant and 29 benign lesions had full 1H-MRS data. The area under the ROC curve (AUC) for prediction of malignancy was 0.816 (R1) and 0.809 (R2). A cutoff of 0.8 mmol/l tCho could diagnose malignancy with a sensitivity of > 95%. For prediction of lymph node metastases, tCho measurements achieved an AUC of 0.760 (R1) and 0.788 (R2). At tCho levels < 2.4 mmol/l, no metastatic lymph nodes were found. Conclusion Quantitative tCho evaluation from 1H-MRS allowed diagnose malignancy and lymph node status in breast lesions suspicious on multiparametric breast MRI. tCho therefore demonstrated the potential to downgrade suspicious mpMRI lesions and stratify the risk of lymph node metastases for improved patient management. Key Points • Quantitative tCho evaluation can distinguish benign from malignant breast lesions suspicious after multiparametric MRI assessment. • Quantitative tCho levels are associated with lymph node status in breast cancer. • Quantitative tCho levels are higher in hormonal receptor positive compared to hormonal receptor negative lesions. Electronic supplementary material The online version of this article (10.1007/s00330-020-06678-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Sodano
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Matthias Dietzel
- Institute of Radiology, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria
| | - Alexander Gussew
- Universitätsklinik und Poliklinik für Radiologie, Ernst-Grube-Str. 40, D-06120, Halle (Saale), Germany
| | - Pascal Andreas Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender, Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090, Vienna, Austria.
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181
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Clauser P, Baltzer PAT, Kapetas P, Hoernig M, Weber M, Leone F, Bernathova M, Helbich TH. Low-Dose, Contrast-Enhanced Mammography Compared to Contrast-Enhanced Breast MRI: A Feasibility Study. J Magn Reson Imaging 2020; 52:589-595. [PMID: 32061002 PMCID: PMC7496227 DOI: 10.1002/jmri.27079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022] Open
Abstract
Contrast‐enhanced MRI (CE‐MRI) is the most sensitive technique for breast cancer detection. Contrast‐enhanced mammography (CEM) is emerging as a possible alternative to CE‐MRI. Purpose To evaluate the diagnostic performance of a low radiation dose contrast‐enhanced mammography (L‐CEM) in women with suspicious findings on conventional imaging compared to CE‐MRI of the breast. Study Type Prospective, single center. Population Women with suspicious findings on mammography, tomosynthesis, or ultrasound, and no contraindications for L‐CEM or CE‐MRI. Eighty women were included. Field Strength/Sequence 1.5 and 3T CE‐MRI, standard protocol for breast, with dedicated coils, according to international guidelines. L‐CEM was performed using a dedicated prototype. Assessment Three, off‐site, blinded readers evaluated the images according to the BI‐RADS lexicon in a randomized order, each in two separate reading sessions. Histology served as a gold standard. Statistical Test Lesion detection rate, sensitivity, specificity, and negative and positive predictive values (NPV, PPV) were calculated and compared with multivariate statistics. Results Included were 80 women (mean age, 54.3 years ±11.2 standard deviation) with 93 lesions (32 benign, 61 malignant). The detection rate was significantly higher with CE‐MRI (92.5–94.6%; L‐CEM 79.6–91.4%, P = 0.014). Sensitivity (L‐CEM 65.6–90.2%; CE‐MRI 83.6–93.4%, P = 0.086) and NPV (L‐CEM 59.6–71.4%; CE‐MRI 63.0–76.5%, P = 0.780) did not differ between the modalities. Specificity (L‐CEM 46.9–96.9%; CE‐MRI 37.5–53.1%, P = 0.001) and PPV (L‐CEM 76.4–97.6%; CE‐MRI 73.3–77.3%, P = 0.007) were significantly higher with L‐CEM. Variations between readers were significant for sensitivity and NPV. The accuracy of L‐CEM was as good as CE‐MRI (75.3–76.3% vs. 72.0–75.3%, P = 0.514). Data Conclusion L‐CEM showed a high sensitivity and accuracy in women with suspicious findings on conventional imaging. Compared to CE‐MRI, L‐CEM has the potential to increase specificity and PPV. L‐CEM might help to reduce false‐positive biopsies while obtaining sensitivity comparable to that of CE‐MRI Level of Evidence 1 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2020;52:589–595.
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Affiliation(s)
- Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mathias Hoernig
- Diagnostic Imaging, Siemens Healthcare GmbH, Forchheim, Germany
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Federica Leone
- ASST Fatebenefratelli-Sacco, Ospedale Fatebenefrateli e Oftalmico, Milan, Italy
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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182
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Breast Cancer Detection-A Synopsis of Conventional Modalities and the Potential Role of Microwave Imaging. Diagnostics (Basel) 2020; 10:diagnostics10020103. [PMID: 32075017 PMCID: PMC7168907 DOI: 10.3390/diagnostics10020103] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 01/11/2023] Open
Abstract
Global statistics have demonstrated that breast cancer is the most frequently diagnosed invasive cancer and the leading cause of cancer death among female patients. Survival following a diagnosis of breast cancer is grossly determined by the stage of the disease at the time of initial diagnosis, highlighting the importance of early detection. Improving early diagnosis will require a multi-faceted approach to optimizing the use of currently available imaging modalities and investigating new methods of detection. The application of microwave technologies in medical diagnostics is an emerging field of research, with breast cancer detection seeing the most significant progress in the last twenty years. In this review, the application of current conventional imaging modalities is discussed, and recurrent shortcomings highlighted. Microwave imaging is rapid and inexpensive. If the preliminary results of its diagnostic capacity are substantiated, microwave technology may offer a non-ionizing, non-invasive, and painless adjunct or stand-alone modality that could possibly be implemented in routine diagnostic breast care.
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Corso G, Magnoni F, Provenzano E, Girardi A, Iorfida M, De Scalzi AM, Invento A, Colleoni M, Cassano E, Trentin C, Gullo RL, Pravettoni G, Gilardi L, Grana CM, Intra M, Galimberti V, Veronesi P, De Lorenzi F, Leonardi MC. Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review. Future Oncol 2020; 16:395-412. [PMID: 32026709 DOI: 10.2217/fon-2019-0540] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multiple synchronous (multifocal or multicentric) ipsilateral breast cancers with heterogeneous histopathology are a rare clinical occurrence, however, their incidence is increasing due to the use of MRI for breast cancer screening and staging. Some studies have demonstrated poorer clinical outcomes for this pattern of breast cancer, but there is no evidence to guide clinical practice. In this multidisciplinary review, we reflect on pathology and molecular characteristics, imaging findings, surgical management including conservation and reconstructive options and approach to the axilla, and the role of chemotherapy and radiotherapy. Multidisciplinary discussions appear decisive in planning an appropriate surgical choice and defining the correct systemic treatment tailored to each clinical condition.
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Affiliation(s)
- Giovanni Corso
- Faculty of Medicine, University of Milan, Milan, Italy.,Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Antonia Girardi
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Monica Iorfida
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Alessandra Invento
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Enrico Cassano
- Division of Breast Imaging, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Trentin
- Division of Breast Imaging, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Lo Gullo
- Division of Breast Imaging, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Faculty of Medicine, University of Milan, Milan, Italy.,Applied Research Division for Cognitive & Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Faculty of Medicine, University of Milan, Milan, Italy.,Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesca De Lorenzi
- Division of Plastic & Reconstructive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
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185
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Peter SC, Wenkel E, Weiland E, Dietzel M, Janka R, Hartmann A, Emons J, Uder M, Ellmann S. Combination of an ultrafast TWIST-VIBE Dixon sequence protocol and diffusion-weighted imaging into an accurate easily applicable classification tool for masses in breast MRI. Eur Radiol 2020; 30:2761-2772. [PMID: 32002644 DOI: 10.1007/s00330-019-06608-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to develop a tool for the classification of masses in breast MRI, based on ultrafast TWIST-VIBE Dixon (TVD) dynamic sequences combined with DWI. TVD sequences allow to abbreviate breast MRI protocols, but provide kinetic information only on the contrast wash-in, and because of the lack of the wash-out kinetics, their diagnostic value might be hampered. A special focus of this study was thus to maintain high diagnostic accuracy in lesion classification. MATERIALS AND METHODS Sixty-one patients who received breast MRI between 02/2014 and 04/2015 were included, with 83 reported lesions (60 malignant). Our institute's standard breast MRI protocol was complemented by an ultrafast TVD sequence. ADC and peak enhancement of the TVD sequences were integrated into a generalised linear model (GLM) for malignancy prediction. For comparison, a second GLM was calculated using ADC and conventional DCE curve type. The resulting GLMs were evaluated for standard diagnostic parameters. For easy application of the GLMs, nomograms were created. RESULTS The GLM based on peak enhancement of the TVD and ADC was as equally accurate as the GLM based on conventional DCE and ADC, with no significant differences (sensitivity, 93.3%/93.3%; specificity, 91.3%/87.0%; PPV, 96.6%/94.9%; NPV, 84.0%/83.3%; all, p ≥ 0.315). CONCLUSIONS This study presents a method to integrate ultrafast TVD sequences into a breast MRI protocol, allowing a reduction of the examination time while maintaining diagnostic accuracy. A GLM based on the combination of TVD-derived peak enhancement and ADC provides high diagnostic accuracy, and can be easily applied using a nomogram. KEY POINTS • Ultrafast TWIST-VIBE Dixon sequence protocols in combination with diffusion-weighted imaging allow to shorten breast MRI examinations, while diagnostic accuracy is maintained. • Integrating peak enhancement from the TWIST-VIBE Dixon sequence and the apparent diffusion coefficient into a generalised linear model provides a comprehensible image evaluation approach. • This approach is further facilitated by nomograms.
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Affiliation(s)
- Sandra C Peter
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Evelyn Wenkel
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Elisabeth Weiland
- Siemens Healthcare GmbH, Allee am Röthelheimpark 2, 91052, Erlangen, Germany
| | - Matthias Dietzel
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Stephan Ellmann
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany.
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D'Amico NC, Grossi E, Valbusa G, Rigiroli F, Colombo B, Buscema M, Fazzini D, Ali M, Malasevschi A, Cornalba G, Papa S. A machine learning approach for differentiating malignant from benign enhancing foci on breast MRI. Eur Radiol Exp 2020; 4:5. [PMID: 31993839 PMCID: PMC6987284 DOI: 10.1186/s41747-019-0131-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Differentiate malignant from benign enhancing foci on breast magnetic resonance imaging (MRI) through radiomic signature. METHODS Forty-five enhancing foci in 45 patients were included in this retrospective study, with needle biopsy or imaging follow-up serving as a reference standard. There were 12 malignant and 33 benign lesions. Eight benign lesions confirmed by over 5-year negative follow-up and 15 malignant histopathologically confirmed lesions were added to the dataset to provide reference cases to the machine learning analysis. All MRI examinations were performed with a 1.5-T scanner. One three-dimensional T1-weighted unenhanced sequence was acquired, followed by four dynamic sequences after intravenous injection of 0.1 mmol/kg of gadobenate dimeglumine. Enhancing foci were segmented by an expert breast radiologist, over 200 radiomic features were extracted, and an evolutionary machine learning method ("training with input selection and testing") was applied. For each classifier, sensitivity, specificity and accuracy were calculated as point estimates and 95% confidence intervals (CIs). RESULTS A k-nearest neighbour classifier based on 35 selected features was identified as the best performing machine learning approach. Considering both the 45 enhancing foci and the 23 additional cases, this classifier showed a sensitivity of 27/27 (100%, 95% CI 87-100%), a specificity of 37/41 (90%, 95% CI 77-97%), and an accuracy of 64/68 (94%, 95% CI 86-98%). CONCLUSION This preliminary study showed the feasibility of a radiomic approach for the characterisation of enhancing foci on breast MRI.
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Affiliation(s)
- Natascha C D'Amico
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy.
- Computer Systems & Bioinformatics Laboratory Department of Engineering, University Campus Bio-Medico of Rome, Via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Enzo Grossi
- Bracco Imaging S.p.A., Via Egidio Folli 50, 20134, Milan, Italy
| | | | - Francesca Rigiroli
- Università degli Studi di Milano, Scuola di specializzazione di Radiodiagnostica, Via Festa del Perdono 7, Milan, Italy
| | - Bernardo Colombo
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
| | - Massimo Buscema
- Centro Ricerche Semeion, Via Sersale 117, 00128, Rome, Italy
| | - Deborah Fazzini
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
| | - Marco Ali
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
| | - Ala Malasevschi
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
| | - Gianpaolo Cornalba
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
| | - Sergio Papa
- Unit of Diagnostic Imaging and Stereotactic Radiotherapy, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
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Wecsler J, Jeong YJ, Raghavendra AS, Mack WJ, Tripathy D, Yamashita MW, Sheth PA, Hovanessian Larsen L, Russell CA, MacDonald H, Sener SF, Lang JE. Factors associated with MRI detection of occult lesions in newly diagnosed breast cancers. J Surg Oncol 2020; 121:589-598. [PMID: 31984517 DOI: 10.1002/jso.25855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The use of preoperative magnetic resonance imaging (MRI) for newly diagnosed breast cancer remains controversial. We examined factors associated with detection of occult multicentric, multifocal, and contralateral malignant lesions only seen by MRI. METHODS We performed a retrospective analysis of consecutive patients undergoing preoperative MRI for breast cancer. Clinicopathologic data were assessed regarding the findings of multifocality, multicentricity, and the presence of contralateral lesions. We analyzed the association of factors with these findings on MRI. RESULTS Of 857 patients undergoing MRI, 770 patients met inclusion criteria. Mean age was 54.7 years. Biopsy-proven detection rates by MRI for multifocal, multicentric, and contralateral cancers were 6.2% (48 of 770), 1.9% (15 of 770) and 3.1% (24 of 770), respectively. African American race and heterogeneously or extremely dense mammographic density were associated with multifocal cancers on MRI. Larger lesion size and mammographic density were associated with multicentric cancers. Invasive lobular carcinoma (ILC) and progesterone receptor (PR)-positivity were associated with contralateral cancers. CONCLUSIONS African American race, heterogeneously or extremely dense mammographic density, ILC, and PR-positivity were associated with additional biopsy-proven cancers based on MRI. These factors should be considered when assessing the clinical utility of preoperative breast MRI.
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Affiliation(s)
- Julie Wecsler
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.,Department of Surgery, LAC + USC (LA County) Medical Center, Los Angeles, California
| | - Young Ju Jeong
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Akshara S Raghavendra
- Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Debasish Tripathy
- Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary W Yamashita
- Division of Oncology Women's Imaging, Department of Radiology and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Pulin A Sheth
- Division of Oncology Women's Imaging, Department of Radiology and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Linda Hovanessian Larsen
- Division of Oncology Women's Imaging, Department of Radiology and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Christy A Russell
- Division of Medical Oncology, Department of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Heather MacDonald
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.,Department of Surgery, LAC + USC (LA County) Medical Center, Los Angeles, California
| | - Stephen F Sener
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.,Department of Surgery, LAC + USC (LA County) Medical Center, Los Angeles, California
| | - Julie E Lang
- Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.,Department of Surgery, LAC + USC (LA County) Medical Center, Los Angeles, California
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188
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Rotili A, Trimboli RM, Penco S, Pesapane F, Tantrige P, Cassano E, Sardanelli F. Double reading of diffusion-weighted magnetic resonance imaging for breast cancer detection. Breast Cancer Res Treat 2020; 180:111-120. [PMID: 31938940 DOI: 10.1007/s10549-019-05519-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To estimate the performance of diffusion-weighted imaging (DWI) for breast cancer detection. METHODS Consecutive breast magnetic resonance imaging examinations performed from January to September 2016 were retrospectively evaluated. Examinations performed before/after neoadjuvant therapy, lacking DWI sequences or reference standard were excluded; breasts after mastectomy were also excluded. Two experienced breast radiologists (R1, R2) independently evaluated only DWI. Final pathology or > 1-year follow-up served as reference standard. Mc Nemar, χ2, and κ statistics were applied. RESULTS Of 1,131 examinations, 672 (59.4%) lacked DWI sequence, 41 (3.6%) had no reference standard, 30 (2.7%) were performed before/after neoadjuvant therapy, and 10 (0.9%) had undergone bilateral mastectomy. Thus, 378 women aged 49 ± 11 years (mean ± standard deviation) were included, 51 (13%) with unilateral mastectomy, totaling 705 breasts. Per-breast cancer prevalence was 96/705 (13.6%). Per-breast sensitivity was 83/96 (87%, 95% confidence interval 78-93%) for both R1 and R2, 89/96 (93%, 86-97%) for double reading (DR) (p = 0.031); per-lesion DR sensitivity for cancers ≤ 10 mm was 22/31 (71%, 52-86%). Per-breast specificity was 562/609 (93%, 90-94%) for R1, 538/609 (88%, 86-91%) for R2, and 526/609 (86%¸ 83-89%) for DR (p < 0.001). Inter-observer agreement was substantial (κ = 0.736). Acquisition time varied from 3:00 to 6:22 min:s. Per-patient median interpretation time was 46 s (R1) and 51 s (R2). CONCLUSIONS DR DWI showed a 93% sensitivity and 88% specificity, with 71% sensitivity for cancers ≤ 10 mm, pointing out a potential for DWI as stand-alone screening method.
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Affiliation(s)
- Anna Rotili
- IEO, European Institute of Oncology IRCCS, Milan, Via Giuseppe Ripamonti, 435, 20141, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Silvia Penco
- IEO, European Institute of Oncology IRCCS, Milan, Via Giuseppe Ripamonti, 435, 20141, Milan, Italy
| | - Filippo Pesapane
- IEO, European Institute of Oncology IRCCS, Milan, Via Giuseppe Ripamonti, 435, 20141, Milan, Italy.,Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Priyan Tantrige
- Unit of Radiology, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Enrico Cassano
- IEO, European Institute of Oncology IRCCS, Milan, Via Giuseppe Ripamonti, 435, 20141, Milan, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
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Leithner D, Helbich TH, Bernard-Davila B, Marino MA, Avendano D, Martinez DF, Jochelson MS, Kapetas P, Baltzer PAT, Haug A, Hacker M, Tanyildizi Y, Morris EA, Pinker K. Multiparametric 18F-FDG PET/MRI of the Breast: Are There Differences in Imaging Biomarkers of Contralateral Healthy Tissue Between Patients With and Without Breast Cancer? J Nucl Med 2020; 61:20-25. [PMID: 31253745 PMCID: PMC6954464 DOI: 10.2967/jnumed.119.230003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
The rationale was to assess whether there are differences in multiparametric 18F-FDG PET/MRI biomarkers of contralateral healthy breast tissue in patients with benign and malignant breast tumors. Methods: In this institutional review board-approved prospective single-institution study, 141 women with imaging abnormalities on mammography or sonography (BI-RADS 4/5) underwent combined 18F-FDG PET/MRI of the breast at 3T with dynamic contrast-enhanced MRI, diffusion-weighted imaging, and the radiotracer 18F-FDG. In all patients, the following imaging biomarkers were recorded for the contralateral (tumor-free) breast: breast parenchymal uptake (BPU) (from 18F-FDG PET), mean apparent diffusion coefficient (from diffusion-weighted imaging), background parenchymal enhancement (BPE), and amount of fibroglandular tissue (FGT) (from MRI). Appropriate statistical tests were used to assess differences in 18F-FDG PET/MRI biomarkers between patients with benign and malignant lesions. Results: There were 100 malignant and 41 benign lesions. BPE was minimal in 61 patients, mild in 56, moderate in 19, and marked in 5. BPE differed significantly (P < 0.001) between patients with benign and malignant lesions, with patients with cancer demonstrating decreased BPE in the contralateral tumor-free breast. FGT approached but did not reach significance (P = 0.055). BPU was 1.5 for patients with minimal BPE, 1.9 for mild BPE, 2.2 for moderate BPE, and 1.9 for marked BPE. BPU differed significantly between patients with benign lesions (mean, 1.9) and patients with malignant lesions (mean, 1.8) (P < 0.001). Mean apparent diffusion coefficient did not differ between groups (P = 0.19). Conclusion: Differences in multiparametric 18F-FDG PET/MRI biomarkers, obtained from contralateral tumor-free breast tissue, exist between patients with benign and patients with malignant breast tumors. Contralateral BPE, BPU, and FGT are decreased in breast cancer patients and may potentially serve as imaging biomarkers for the presence of malignancy.
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Affiliation(s)
- Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Blanca Bernard-Davila
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, Nuevo Leon, Mexico
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Panagiotis Kapetas
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal A T Baltzer
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Medical University of Vienna, Vienna, Austria; and
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Yasemin Tanyildizi
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Girometti R, Marconi V, Linda A, Di Mico L, Bondini F, Zuiani C, Sardanelli F. Preoperative assessment of breast cancer: Multireader comparison of contrast-enhanced MRI versus the combination of unenhanced MRI and digital breast tomosynthesis. Breast 2019; 49:174-182. [PMID: 31838292 PMCID: PMC7375544 DOI: 10.1016/j.breast.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To compare the sensitivity for breast cancer (BC) and BC size estimation of preoperative contrast-enhanced magnetic resonance imaging (CEMRI) versus combined unenhanced magnetic resonance imaging (UMRI) and digital breast tomosynthesis (DBT). PATIENTS AND METHODS We retrospectively included 56 women who underwent DBT and preoperative 1.5 T CEMRI between January 2016-February 2017. Three readers with 2-10 years of experience in CEMRI and DBT, blinded to pathology, independently reviewed CEMRI (diffusion-weighted imaging [DWI], T2-weighted imaging, pre- and post-contrast T1-weighted imaging) and a combination of UMRI (DWI and pre-contrast T1-weighted imaging) and DBT. We calculated per-lesion sensitivity of CEMRI and UMRI + DBT, and the agreement between CEMRI, UMRI and DBT versus pathology in assessing cancer size (Bland-Altman analysis). Logistic regression was performed to assess features predictive of cancer missing. RESULTS We included 70 lesions (64% invasive BC, 36% ductal carcinoma in situ or invasive BC with in situ component). UMRI + DBT showed lower sensitivity (86-89%) than CEMRI (94-100%), with a significant difference for the most experienced reader only (p = 0.008). False-positives were fewer with UMRI + DBT (4-5) than with CEMRI (18-25), regardless of the reader (p = 0.001-0.005). For lesion size, UMRI showed closer limits of agreement with pathology than CEMRI or DBT. Cancer size ≤1 cm was the only independent predictor for cancer missing for both imaging strategies (Odds ratio 8.62 for CEMRI and 19.16 for UMRI + DBT). CONCLUSIONS UMRI + DBT showed comparable sensitivity and less false-positives than CEMRI in the preoperative assessment of BC. UMRI was the most accurate tool to assess cancer size.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Valentina Marconi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Anna Linda
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Luisa Di Mico
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Federica Bondini
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria Della Misericordia", P.le S. Maria Della Misercordia N, 15, 33100, Udine, Italy.
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy.
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Wengert GJ, Pipan F, Almohanna J, Bickel H, Polanec S, Kapetas P, Clauser P, Pinker K, Helbich TH, Baltzer PAT. Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. Eur Radiol 2019; 30:1451-1459. [PMID: 31797077 PMCID: PMC7033072 DOI: 10.1007/s00330-019-06444-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 01/28/2023]
Abstract
Objectives To investigate whether the application of the Kaiser score for breast magnetic resonance imaging (MRI) might downgrade breast lesions that present as mammographic calcifications and avoid unnecessary breast biopsies Methods This IRB-approved, retrospective, cross-sectional, single-center study included 167 consecutive patients with suspicious mammographic calcifications and histopathologically verified results. These patients underwent a pre-interventional breast MRI exam for further diagnostic assessment before vacuum-assisted stereotactic-guided biopsy (95 malignant and 72 benign lesions). Two breast radiologists with different levels of experience independently read all examinations using the Kaiser score, a machine learning–derived clinical decision-making tool that provides probabilities of malignancy by a formalized combination of diagnostic criteria. Diagnostic performance was assessed by receiver operating characteristics (ROC) analysis and inter-reader agreement by the calculation of Cohen’s kappa coefficients. Results Application of the Kaiser score revealed a large area under the ROC curve (0.859–0.889). Rule-out criteria, with high sensitivity, were applied to mass and non-mass lesions alike. The rate of potentially avoidable breast biopsies ranged between 58.3 and 65.3%, with the lowest rate observed with the least experienced reader. Conclusions Applying the Kaiser score to breast MRI allows stratifying the risk of breast cancer in lesions that present as suspicious calcifications on mammography and may thus avoid unnecessary breast biopsies. Key Points • The Kaiser score is a helpful clinical decision tool for distinguishing malignant from benign breast lesions that present as calcifications on mammography. • Application of the Kaiser score may obviate 58.3–65.3% of unnecessary stereotactic biopsies of suspicious calcifications. • High Kaiser scores predict breast cancer with high specificity, aiding clinical decision-making with regard to re-biopsy in case of negative results.
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Affiliation(s)
- G J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - F Pipan
- Institute of Diagnostic Radiology, University of Udine, Udine, Italy
| | - J Almohanna
- Security Forces Hospital, Riyadh, Saudi Arabia
| | - H Bickel
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - S Polanec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - K Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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193
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Cozzi A, Schiaffino S, Sardanelli F. The emerging role of contrast-enhanced mammography. Quant Imaging Med Surg 2019; 9:2012-2018. [PMID: 31929976 DOI: 10.21037/qims.2019.11.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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194
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Arfi Rouche J, Gavrel M, Feki R, Balleyguier C. Prise en charge préopératoire du cancer du sein : tomosynthèse/angiomammographie/IRM, millefeuille ou sur mesure ? IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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195
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Baltzer P, Mann RM, Iima M, Sigmund EE, Clauser P, Gilbert FJ, Martincich L, Partridge SC, Patterson A, Pinker K, Thibault F, Camps-Herrero J, Le Bihan D. Diffusion-weighted imaging of the breast-a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working group. Eur Radiol 2019; 30:1436-1450. [PMID: 31786616 PMCID: PMC7033067 DOI: 10.1007/s00330-019-06510-3] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/03/2019] [Accepted: 10/10/2019] [Indexed: 01/03/2023]
Abstract
The European Society of Breast Radiology (EUSOBI) established an International Breast DWI working group. The working group consists of clinical breast MRI experts, MRI physicists, and representatives from large vendors of MRI equipment, invited based upon proven expertise in breast MRI and/or in particular breast DWI, representing 25 sites from 16 countries. The aims of the working group are (a) to promote the use of breast DWI into clinical practice by issuing consensus statements and initiate collaborative research where appropriate; (b) to define necessary standards and provide practical guidance for clinical application of breast DWI; (c) to develop a standardized and translatable multisite multivendor quality assurance protocol, especially for multisite research studies; (d) to find consensus on optimal methods for image processing/analysis, visualization, and interpretation; and (e) to work collaboratively with system vendors to improve breast DWI sequences. First consensus recommendations, presented in this paper, include acquisition parameters for standard breast DWI sequences including specifications of b values, fat saturation, spatial resolution, and repetition and echo times. To describe lesions in an objective way, levels of diffusion restriction/hindrance in the breast have been defined based on the published literature on breast DWI. The use of a small ROI placed on the darkest part of the lesion on the ADC map, avoiding necrotic, noisy or non-enhancing lesion voxels is currently recommended. The working group emphasizes the need for standardization and quality assurance before ADC thresholds are applied. The working group encourages further research in advanced diffusion techniques and tailored DWI strategies for specific indications. Key Points • The working group considers breast DWI an essential part of a multiparametric breast MRI protocol and encourages its use. • Basic requirements for routine clinical application of breast DWI are provided, including recommendations on b values, fat saturation, spatial resolution, and other sequence parameters. • Diffusion levels in breast lesions are defined based on meta-analysis data and methods to obtain a reliable ADC value are detailed.
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Affiliation(s)
- Pascal Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Centre, Nijmegen, Netherlands. .,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eric E Sigmund
- Department of Radiology, New York University School of Medicine, NYU Langone Health, Ney York, NY, 10016, USA
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew Patterson
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/Vienna General Hospital, Wien, Austria.,MSKCC, New York, NY, 10065, USA
| | | | | | - Denis Le Bihan
- NeuroSpin, Frédéric Joliot Institute, Gif Sur Yvette, France
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Mariscotti G, Durando M, Tagliafico A, Campanino PP, Bosco D, Casella C, Bussone R, Ala A, Castellano I, Sapino A, Bergamasco L, Fonio P, Houssami N. Preoperative breast cancer staging with multi-modality imaging and surgical outcomes. Eur J Radiol 2019; 122:108766. [PMID: 31809942 DOI: 10.1016/j.ejrad.2019.108766] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/10/2019] [Accepted: 11/20/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare the rates of mastectomy and re-operation after breast-conserving surgery (BCS) among patients who had different pre-operative multi-modality imaging, hence identifying significant predictors of mastectomy and re-operations within each group. METHOD Retrospective study of consecutive patients with primary breast cancer treated January 2010 - December 2016, divided in 3 groups, undergoing pre-operative local staging respectively with conventional imaging modalities only (2D mammography, ultrasound (US)), conventional imaging and tomosynthesis (DBT) and/or MRI. The primary outcome was identification of significant predictors of surgical outcomes, within each group. Study variables examined in univariate analysis were age, lesion dimension, breast density, multifocality, tumor size, histology, and if associated with outcomes they were included in binary logistic regression analysis. RESULTS Amongst 1547 patients, patient and tumor characteristics differed across the three groups, as did mastectomy rates which were 18 % (102/562) for 2D + US, 36 % (154/428) for 2D + DBT + US, 45 % (250/557) for 2D+/-DBT + US + MRI(p < 0.001). Variables strongly associated with mastectomy were larger lesions and multifocality (as was multi-modality group). Re-operation rate showed an opposite trend: 12.2 % (56/459) for 2D + US, 8 % (22/272) for 2D + DBT + US, 6.5 % (20/306) for 2D+/-DBT + US + MRI. Re-operation rate for 2D+/-DBT + US + MRI was lower than for 2D + US (p = 0.01) but similar to 2D + DBT + US (p = 0.58). Patients who had 2D + US and re-operations had significantly larger lesions, more underestimation, higher proportion of invasive carcinoma with in-situ component than those who did not require re-operation. CONCLUSIONS Patients who had larger tumors and multifocal disease were more frequently staged by adding DBT and/or MRI to conventional imaging (mammography and US) which was associated with more extensive surgical treatment but lower reoperation rates.
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Affiliation(s)
- Giovanna Mariscotti
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Manuela Durando
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Alberto Tagliafico
- Department of Experimental Medicine, University of Genoa, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, 16132, Genoa, Italy.
| | - Pier Paolo Campanino
- Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100, Torino, Italy.
| | - Davide Bosco
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Cristina Casella
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Riccardo Bussone
- Breast Surgery, Presidio Sanitario Ospedale Cottolengo, Via S. Giuseppe Benedetto Cottolengo, 9, 10152, Torino, Italy.
| | - Ada Ala
- Breast Surgery, Department of Surgery, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero S. Anna, Via Ventimiglia, 1, 10126, Torino, Italy.
| | - Isabella Castellano
- Department of Biomedical Sciences and Human Oncology, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Santena, 7, Torino, Italy.
| | - Anna Sapino
- Fondazione del Piemonte per l'Oncologia (FPO), Candiolo Cancer Institute (IRCCs), 10060, Candiolo, Torino, Italy.
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, C.so Bramante 88, 10126, Torino, Italy.
| | - Paolo Fonio
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza di Torino, Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2006, NSW, Australia.
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Thorat MA, Balasubramanian R. Breast cancer prevention in high-risk women. Best Pract Res Clin Obstet Gynaecol 2019; 65:18-31. [PMID: 31862315 DOI: 10.1016/j.bpobgyn.2019.11.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022]
Abstract
Women at high risk of developing breast cancer are a heterogeneous group of women including those with and without high-risk germline mutation/s. Prevention in these women requires a personalised and multidisciplinary approach. Preventive therapy with selective oestrogen receptor modulators (SERMs) like tamoxifen and aromatase inhibitors (AIs) substantially reduces breast cancer risk well beyond the active treatment period. The importance of benign breast disease as a marker of increased breast cancer risk remains underappreciated, and although the benefit of preventive therapy may be greater in such women, preventive therapy remains underutilised in these and other high-risk women. Bilateral Risk-Reducing Mastectomy (BRRM) reduces the risk of developing breast cancer by 90% in high-risk women such as carriers of BRCA mutations. It also improves breast cancer-specific survival in BRCA1 carriers. Bilateral risk-reducing salpingo-oophorectomy may also reduce risk in premenopausal BRCA2 carriers. Further research to improve risk models, to identify surrogate biomarkers of preventive therapy benefit and to develop newer preventive agents is needed.
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Affiliation(s)
- Mangesh A Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom; School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, United Kingdom; Breast Services, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom.
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198
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Cattafi A, Santarpia M, Micalizzi MF, Sofia C, Condorelli E, Dottore A, Altavilla G, Blandino A, Ascenti G, Marino MA. Bone and lymph node metastases from occult mammary carcinoma: a case report of carcinoma of unknown primary (CUP) Syndrome. BJR Case Rep 2019; 5:20190064. [PMID: 31938570 PMCID: PMC6945249 DOI: 10.1259/bjrcr.20190064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
Cancer of unknown provenance is a rare disease, accounting approximately for up to 1% of all breast cancers. A 68-year-old female was admitted to the Medical Oncology Unit of Policlinico Universitario G.Martino because of diffused bone-involvement, with mixed (osteolytic/osteoblastic) features, which interested almost every skeletal structure of the body (vertebral bodies of the entire column, costal skeleton, sternum, proximal third of both humeri, scapulae, clavicles, pelvis and femurs), suspicious for metastatic disease.
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Affiliation(s)
- Antonino Cattafi
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Mariacarmela Santarpia
- Department of Human Pathology of Adult and Evolutive Age "G. Barresi" Medical Oncology Unit, University of Messina, Messina, Italy
| | - Martina Francesca Micalizzi
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Elvira Condorelli
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Alessia Dottore
- Department of Human Pathology of Adult and Evolutive Age "G. Barresi" Medical Oncology Unit, University of Messina, Messina, Italy
| | - Giuseppe Altavilla
- Department of Human Pathology of Adult and Evolutive Age "G. Barresi" Medical Oncology Unit, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
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Tagliafico AS, Piana M, Schenone D, Lai R, Massone AM, Houssami N. Overview of radiomics in breast cancer diagnosis and prognostication. Breast 2019; 49:74-80. [PMID: 31739125 PMCID: PMC7375670 DOI: 10.1016/j.breast.2019.10.018] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Diagnosis of early invasive breast cancer relies on radiology and clinical evaluation, supplemented by biopsy confirmation. At least three issues burden this approach: a) suboptimal sensitivity and suboptimal positive predictive power of radiology screening and diagnostic approaches, respectively; b) invasiveness of biopsy with discomfort for women undergoing diagnostic tests; c) long turnaround time for recall tests. In the screening setting, radiology sensitivity is suboptimal, and when a suspicious lesion is detected and a biopsy is recommended, the positive predictive value of radiology is modest. Recent technological advances in medical imaging, especially in the field of artificial intelligence applied to image analysis, hold promise in addressing clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. Radiomics include feature extraction from clinical images; these features are related to tumor size, shape, intensity, and texture, collectively providing comprehensive tumor characterization, the so-called radiomics signature of the tumor. Radiomics is based on the hypothesis that extracted quantitative data derives from mechanisms occurring at genetic and molecular levels. In this article we focus on the role and potential of radiomics in breast cancer diagnosis and prognostication.
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Affiliation(s)
- Alberto Stefano Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino, Genoa, Italy.
| | - Michele Piana
- Dipartimento di Matematica, Università di Genova, Genova, Italy; CNR - SPIN, Genova, Italy
| | | | | | - Anna Maria Massone
- Dipartimento di Matematica, Università di Genova, Genova, Italy; CNR - SPIN, Genova, Italy
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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200
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Ceugnart L, Olivier A, Oudoux A. [Breast cancer: News tools in imaging]. Presse Med 2019; 48:1101-1111. [PMID: 31676215 DOI: 10.1016/j.lpm.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022] Open
Abstract
Breast cancer imaging is always improving for the last 20 years in spite of digitalization and computer development. News tools in mammography (Digital Breast Tomosynthesis, Contrast enhanced mammography), sonography (elastography, Automated echography), MRI (Diffusion, abbreviated MRI) and Nuclear medicine has the great potential to be the future of breats imaging. But true revolution will be to use the huge volume of "hidden" imaging data, by Intelligence Artificial process or Biological progress (in genomics, proteiomics) to purpose to our patient a personalized imaging.
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Affiliation(s)
- Luc Ceugnart
- Centre régional de lutte contre le cancer Oscar-Lambret, pôle imagerie, secteur imagerie, Lille, France.
| | - Anais Olivier
- Centre régional de lutte contre le cancer Oscar-Lambret, pôle imagerie, secteur médecine nucléaire, Lille, France
| | - Aurore Oudoux
- Centre régional de lutte contre le cancer Oscar-Lambret, pôle imagerie, secteur médecine nucléaire, Lille, France
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