151
|
Impact of 18F-FDG PET/MR on therapeutic management in high risk primary breast cancer patients - A prospective evaluation of staging algorithms. Eur J Radiol 2020; 128:108975. [PMID: 32371185 DOI: 10.1016/j.ejrad.2020.108975] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate whether potential differences in staging between a traditional staging imaging algorithm and 18F-FDG PET/MR lead to a change in patient management in breast carcinoma and to compare the diagnostic accuracy between the traditional staging algorithm and 18F-FDG PET/MR for the TNM classification. METHOD In this prospective cohort study from two university hospitals 56 women with newly diagnosed, therapy-naive breast cancer and increased pre-test probability for distant metastases were included. All patients were examined by a traditional staging imaging algorithm (X-ray mammography, breast ultrasonography, chest plain radiography, bone scintigraphy, and ultrasonography of the liver and axillary fossa) and whole-body 18F-FDG PET/MR including dedicated 18F-FDG PET/MR breast examinations. Each patient was discussed two times in a separate tumor board session to determine a total of three therapy recommendations based on histopathological data of the primary tumor and (1) traditional algorithm only, (2) traditional algorithm and 18F-FDG PET/MR, and (3) 18F-FDG PET/MR only. Major changes in therapy recommendations and differences between the traditional staging algorithm and 18F-FDG PET/MR for the TNM classification were evaluated. RESULTS Staging by 18F-FDG PET/MR led to a difference in treatment compared the traditional staging algorithm in 8/56 cases (14%). Therapy changes included therapy of the breast, locoregional nodes and systemic therapy. A trend to staging superiority was found for 18F-FDG PET/MRI without statistical significance (p = 0.3827). CONCLUSION In conclusion, for breast cancer patients with elevated pre-test probability for distant metastases a change of the therapy regiment occurs in 14 % of patients when staged by 18F-FDG PET/MR and confirmed by histopathology compared to a traditional staging algorithm. In particular with regard to the amendment of the guideline further assessment of 18F-FDG-PET/MR in this setting is necessary to assess the true value of this modality.
Collapse
|
152
|
Ruiz-Flores L, Whitman GJ, Le-Petross HTC, Hess KR, Parikh JR. Variation in Technical Quality of Breast MRI. Acad Radiol 2020; 27:468-475. [PMID: 31371208 DOI: 10.1016/j.acra.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Breast magnetic resonance imaging (MRI) quality may vary across the United States. Our aim was to investigate the quality of outside breast MRIs presenting for second opinion at a tertiary cancer center following implementation of the American College of Radiology (ACR) Breast MRI Accreditation Program. MATERIALS AND METHODS We retrospectively reviewed the technical quality of the MRI studies of 100 consecutive cases submitted for second opinion in 2013. The image quality was blindly reviewed per ACR Breast MRI Accreditation Program by three fellowship-trained breast radiologists and one breast imaging fellow. RESULTS In total, 88 of the 100 cases were referred from facilities in the United States. Sixty (68%) of the 88 cases had at least one technical deficiency. In 10 cases (11%), more than five different technical deficiencies occurred. The most frequently encountered deficiencies were related to artifacts (74%), with shimming (N = 17) and motion (N = 16) being the most common. In total, 38% of cases (N = 33) had a deficient T2-weighted sequence, mostly due to low signal to noise ratio (N = 25). A total of 27% cases (N = 24) had deficiencies in the delayed phase postcontrast T1-weighted sequence, mainly due to low signal to noise ratio (N = 21) and 23% had deficiencies in the early phase postcontrast T1-weighted sequence, predominantly due to low signal to noise ratio as well. (N = 19). CONCLUSION Our study demonstrates variability of breast MRI quality across the United States. Radiologists should become familiar with the requirements of the ACR breast MRI accreditation program and strive to meet the expected standards in order to enhance patient quality and safety.
Collapse
Affiliation(s)
- Lorell Ruiz-Flores
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030.
| | - Gary J Whitman
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| | - H T Carissa Le-Petross
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay R Parikh
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| |
Collapse
|
153
|
Miller MM, Repich K, Patrie JT, Anderson RT, Harvey JA. Preferences and Attitudes Regarding Adjunct Breast Cancer Screening Among Patients with Dense Breasts. JOURNAL OF BREAST IMAGING 2020; 2:119-124. [PMID: 38424895 DOI: 10.1093/jbi/wbz093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE New breast screening modalities are being investigated to address the need for more sensitive breast cancer screening in women with dense breasts. We investigated the preferences and attitudes of these patients regarding adjunct screening modalities to help evaluate the acceptability of these exams. METHODS In this institutional review board-approved prospective study, patients with dense breasts on their prior mammogram were invited to complete a survey. Patients were asked to estimate their personal breast cancer risk compared with peers, indicate their level of concern related to screening callbacks, radiation exposure, and intravenous (IV) contrast allergies, and identify which factors might deter them from getting adjunct screening exams. RESULTS Five hundred eight patients with dense breasts presenting for screening mammography completed surveys. While most patients (304/508, 59.9%) felt it was likely or very likely that cancer could be missed on their mammogram, only 8.9% (45/508) had undergone adjunct screening exams in the past 3 years. The most commonly cited deterrents to adjunct screening were cost (340/508, 66.9%), pain (173/508, 34.1%), and concern that adjunct screening could lead to additional procedures (158/508, 31.1%). When asked to select among three hypothetical breast cancer screening modalities, patients strongly preferred the more sensitive examination, even if this involved greater cost (162/508, 31.9%) or IV-contrast administration (315/508, 62.0%). CONCLUSION Our data suggest that patients with dense breasts prefer adjunct screening exams that are both sensitive and inexpensive, although an increase in sensitivity could outweigh additional cost or even IV-line placement.
Collapse
Affiliation(s)
- Matthew M Miller
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA
| | - Kathy Repich
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA
| | - James T Patrie
- University of Virginia School of Medicine, Department of Public Health Sciences, Charlottesville, VA
| | - Roger T Anderson
- University of Virginia School of Medicine, Department of Public Health Sciences, Charlottesville, VA
| | - Jennifer A Harvey
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA
| |
Collapse
|
154
|
Fernández-Nogueira P, Mancino M, Fuster G, Bragado P, Prats de Puig M, Gascón P, Casado FJ, Carbó N. Breast Mammographic Density: Stromal Implications on Breast Cancer Detection and Therapy. J Clin Med 2020; 9:jcm9030776. [PMID: 32178425 PMCID: PMC7141321 DOI: 10.3390/jcm9030776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022] Open
Abstract
Current evidences state clear that both normal development of breast tissue as well as its malignant progression need many-sided local and systemic communications between epithelial cells and stromal components. During development, the stroma, through remarkably regulated contextual signals, affects the fate of the different mammary cells regarding their specification and differentiation. Likewise, the stroma can generate tumour environments that facilitate the neoplastic growth of the breast carcinoma. Mammographic density has been described as a risk factor in the development of breast cancer and is ascribed to modifications in the composition of breast tissue, including both stromal and glandular compartments. Thus, stroma composition can dramatically affect the progression of breast cancer but also its early detection since it is mainly responsible for the differences in mammographic density among individuals. This review highlights both the pathological and biological evidences for a pivotal role of the breast stroma in mammographic density, with particular emphasis on dense and malignant stromas, their clinical meaning and potential therapeutic implications for breast cancer patients.
Collapse
Affiliation(s)
- Patricia Fernández-Nogueira
- Institut d’Investigacions Biomèdiques Augustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Correspondence: (P.F.-N.); (M.M.)
| | - Mario Mancino
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Institute of Biomedicine, University of Barcelona (IBUB), 08028 Barcelona, Spain
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Correspondence: (P.F.-N.); (M.M.)
| | - Gemma Fuster
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Institute of Biomedicine, University of Barcelona (IBUB), 08028 Barcelona, Spain
- Department of Biochemistry & Physiology, School of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain
- Department of Biosciences, Faculty of Sciences and Technology, University of Vic, 08500 Vic, Spain
| | - Paloma Bragado
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University of Madrid, Health Research Institute of the Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Miquel Prats de Puig
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Breast Committee, Hospital El Pilar, Quirón salud Group, 08006 Barcelona, Spain
| | - Pere Gascón
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Institute of Biomedicine, University of Barcelona (IBUB), 08028 Barcelona, Spain
- Oncology and Multidisciplinary Knowledge, 08036 Barcelona, Spain
| | - Francisco Javier Casado
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Institute of Biomedicine, University of Barcelona (IBUB), 08028 Barcelona, Spain
| | - Neus Carbó
- Department of Biochemistry and Molecular Biomedicine, University of Barcelona, Institute of Biomedicine, University of Barcelona (IBUB), 08028 Barcelona, Spain
| |
Collapse
|
155
|
An YY, Kim SH, Kang BJ, Suh YJ, Jeon YW. Feasibility of abbreviated magnetic resonance imaging (AB-MRI) screening in women with a personal history (PH) of breast cancer. PLoS One 2020; 15:e0230347. [PMID: 32163500 PMCID: PMC7067463 DOI: 10.1371/journal.pone.0230347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/27/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the feasibility of abbreviated magnetic resonance imaging (AB-MRI) in women with a personal history (PH) of breast cancer as a screening tool. MATERIALS AND METHODS We retrospectively reviewed 1880 screening AB-MRIs in 763 women with a PH of breast cancer (median age, 55 years; range, 23-89 years) between October 2015 and October 2016. The total acquisition times of AB-MRI were 8.3 min and 2.8 min with and without T2-weighted imaging, respectively. The tissue diagnosis or one-year follow-up status was used as the reference standard. The characteristics of tumor recurrences detected on AB-MRI screenings were analyzed. The cancer detection rates (CDRs) and additional CDRs for the 1st round and overall rounds of AB-MRI screening were calculated. The recall rate, sensitivity, specificity, positive predictive values for recall (PPV1) and biopsy (PPV3) for the 1st round of AB-MRI screening were calculated. The diagnostic performance of the combination of mammography and ultrasonography was compared with that of AB-MRI by receiver operating characteristic (ROC) curve analysis. RESULTS Fifteen of a total of 21 recurrences were detected on the 1st round of AB-MRI screening: 93.3% were node-negative T1 tumors (median tumor size, 1.02 cm; range, 0.1-2 cm) or Tis; 66.7% were high-grade tumors; 8 of these 15 were mammographically and ultrasonographically occult. The CDR and additional CDR for the 1st round of AB-MRI screening were 0.019 and 0.010 per woman, respectively. The sensitivity, specificity, recall rate, PPV1 and PPV3 for the 1st round of AB-MRI screening were 100%, 96.0%, 14.3%, 13.8% and 58.3%, respectively. For detecting secondary cancer, AB-MRI showed a higher sensitivity and PPV than the combination of mammography and ultrasonography (95.2%, 57.1% vs 47.6%, 38.5%). The area under the ROC curve was higher for AB-MRI (0.966; 95% CI: 0.951-0.978) than the combination of mammography and ultrasonography (0.727; 95% CI: 0.694-0.759) (P<0.0001). CONCLUSION AB-MRI improved cancer detection with a high specificity, sensitivity and PPV in women with a PH of breast cancer. AB-MRI could be a useful screening tool for detecting secondary cancer considering its high diagnostic performance and short examination time.
Collapse
Affiliation(s)
- Yeong Yi An
- Department of Radiology, The Catholic University of Korea, St. Vincent’s Hospital, College of Medicine, Suwon-si, Korea
| | - Sung Hun Kim
- Department of Radiology, The Catholic University of Korea, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, The Catholic University of Korea, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
- * E-mail:
| | - Young Jin Suh
- Department of Surgery, The Catholic University of Korea, St. Vincent’s Hospital, College of Medicine, Seoul, Korea
| | - Ye Won Jeon
- Department of Surgery, The Catholic University of Korea, St. Vincent’s Hospital, College of Medicine, Seoul, Korea
| |
Collapse
|
156
|
Computer-Aided Diagnosis in Multiparametric Magnetic Resonance Imaging Screening of Women With Extremely Dense Breasts to Reduce False-Positive Diagnoses. Invest Radiol 2020; 55:438-444. [DOI: 10.1097/rli.0000000000000656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
157
|
Comstock CE, Gatsonis C, Newstead G, Snyder BS, Gareen IF, Bergin JT, Rahbar H, Sung JS, Jacobs C, Harvey JA, Nicholson MH, Ward RC, Holt J, Prather A, Miller KD, Schnall MD, Kuhl CK. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA 2020; 323:746-756. [PMID: 32096852 PMCID: PMC7276668 DOI: 10.1001/jama.2020.0572] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. OBJECTIVE To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. EXPOSURES All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. MAIN OUTCOMES AND MEASURES The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. RESULTS Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). CONCLUSIONS AND RELEVANCE Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02933489.
Collapse
Affiliation(s)
| | - Constantine Gatsonis
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ilana F. Gareen
- Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Habib Rahbar
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Janice S. Sung
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Jenifer A. Harvey
- University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | | | | | | | | | | | | | | |
Collapse
|
158
|
Bae MS, Sung JS, Bernard-Davila B, Sutton EJ, Comstock CE, Morris EA. Survival Outcomes of Screening with Breast MRI in Women at Elevated Risk of Breast Cancer. JOURNAL OF BREAST IMAGING 2020; 2:29-35. [PMID: 32055796 DOI: 10.1093/jbi/wbz083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/01/2019] [Indexed: 02/01/2023]
Abstract
Objective To determine survival outcomes in women with breast cancer detected at combined screening with breast MRI and mammography versus screening mammography alone. Methods This is an institutional review board-approved retrospective study, and the need for informed consent was waived. A total of 3002 women with an increased risk of breast cancer were screened between 2001 and 2004. Of the 3002 women, 1534 (51.1%) had 2780 combined screenings (MRI and mammography) and 1468 (48.9%) had 4811 mammography-only screenings. The Χ 2 test and the Kaplan-Meier method were used to compare cancer detection rates and survival rates. Results The overall cancer detection rate was significantly higher in the MRI plus mammography group compared with the mammography-only group (1.4% [40 of 2780] vs 0.5% [23 of 4811]; P < 0.001). No interval cancers occurred in the MRI plus mammography group, whereas 9 interval cancers were found in the mammography-only group. During a median follow-up of 10.9 years (range: 0.7 to 15.2), a total of 11 recurrences and 5 deaths occurred. Of the 11 recurrences, 6 were in the MRI plus mammography group and 5 were in the mammography-only group. All five deaths occurred in the mammography-only group. Disease-free survival showed no statistically significant difference between the two groups (P = 0.32). However, overall survival was significantly improved in the MRI plus mammography group (P = 0.002). Conclusion Combined screening with MRI and mammography in women at elevated risk of breast cancer improves cancer detection and overall survival.
Collapse
Affiliation(s)
- Min Sun Bae
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Janice S Sung
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | | | - Elizabeth J Sutton
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | | | - Elizabeth A Morris
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| |
Collapse
|
159
|
Vincent JM, Rispoli JV. Stitching Stretchable Radiofrequency Coils for MRI: A Conductive Thread and Athletic Fabric Approach .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6798-6801. [PMID: 31947401 DOI: 10.1109/embc.2019.8857051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We propose a novel flexible and entirely stretchable radiofrequency coil for magnetic resonance imaging. This coil design aims at increasing patient comfort during joint imaging while maintaining or improving image quality. METHODS Conductive silver-coated thread was stitched in a zigzag pattern onto stretchable athletic fabric to create a single-loop receive coil. The stitched coil was mounted in a draped and stretched fashion and compared to a coil fabricated on flexible printed circuit board. Match/tune circuits, detuning circuits, and baluns were incorporated into the final setup for bench measurements and imaging on a 3T MR scanner. A fast spin echo sequence was used to obtain images for comparison. RESULTS The fabricated coil presents multi-directional stretchability and flexibility while maintaining conductivity and stitch integrity. Quality factor measurements and SNR calculations show that this stretchable coil design is comparable to a flexible, standard PCB coil. Detailed human wrist images were successfully obtained in vivo using the stretched, stitched coil. CONCLUSION The resulting MR images and SNR calculations support further experimentation into more complex coil geometries. SIGNIFICANCE This coil is uniquely stretchable in all direction and allows for joint imaging at various degrees of flexion. Additionally, this coil offers the closest proximity of placement to the skin with materials that provide a similar level of comfort to that of athletic wear and compression sleeves. This stitched design could be incorporated into coils for a variety of anatomies.
Collapse
|
160
|
Ko ES, Morris EA. Abbreviated Magnetic Resonance Imaging for Breast Cancer Screening: Concept, Early Results, and Considerations. Korean J Radiol 2020; 20:533-541. [PMID: 30887736 PMCID: PMC6424827 DOI: 10.3348/kjr.2018.0722] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/27/2018] [Indexed: 12/29/2022] Open
Abstract
Breast magnetic resonance imaging (MRI) has been increasingly utilized, especially in screening for high-risk cases, because of its high sensitivity and superior ability to detect cancers as compared with mammography and ultrasound. Several limitations such as higher cost, longer examination time, longer interpretation time, and low availability have hindered the wider application of MRI, especially for screening of average-risk women. To overcome some of these limitations and increase access to MRI screening, an abbreviated breast MRI protocol has been introduced. Abbreviated breast MRI is becoming popular and challenges the status quo. This review aims to present an overview of abbreviated MRI, discuss the current findings, and introduce ongoing prospective trials.
Collapse
Affiliation(s)
- Eun Sook Ko
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
161
|
Schünemann HJ, Lerda D, Quinn C, Follmann M, Alonso-Coello P, Rossi PG, Lebeau A, Nyström L, Broeders M, Ioannidou-Mouzaka L, Duffy SW, Borisch B, Fitzpatrick P, Hofvind S, Castells X, Giordano L, Canelo-Aybar C, Warman S, Mansel R, Sardanelli F, Parmelli E, Gräwingholt A, Saz-Parkinson Z. Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Ann Intern Med 2020; 172:46-56. [PMID: 31766052 DOI: 10.7326/m19-2125] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers. METHODS An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence. RECOMMENDATIONS This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.
Collapse
Affiliation(s)
| | - Donata Lerda
- European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.)
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland (C.Q.)
| | | | | | - Paolo Giorgi Rossi
- Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggia Emilia, Italy (P.G.R.)
| | - Annette Lebeau
- Private Group Practice for Pathology, Lübeck, Germany (A.L.)
| | | | | | | | - Stephen W Duffy
- Queen Mary University of London, London, United Kingdom (S.W.D.)
| | | | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (X.C.)
| | - Livia Giordano
- CPO-Piedmont - AOU Cittá della Salute e della Scienza, Torino, Italy (L.G.)
| | | | - Sue Warman
- Langford, North Somerset, United Kingdom (S.W.)
| | | | | | - Elena Parmelli
- European Commission, Joint Research Centre, Ispra, Italy (D.L., E.P., Z.S.)
| | | | | | | |
Collapse
|
162
|
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.
Collapse
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
| |
Collapse
|
163
|
Abstract
OBJECTIVE. Fast breast MRI protocols have the same sensitivity as conventional protocols, but their specificity is variable and can be inadequate. An ultrafast sequence provides early enhancement of lesion characteristics that optimize the characterization of the fast protocol, increasing positive predictive values without increasing time. CONCLUSION. These new abbreviated protocols could constitute a viable screening tool both for women at high risk of breast cancer and for those at intermediate risk with high breast density.
Collapse
|
164
|
Kuhl CK. Abbreviated Magnetic Resonance Imaging (MRI) for Breast Cancer Screening: Rationale, Concept, and Transfer to Clinical Practice. Annu Rev Med 2019; 70:501-519. [PMID: 30691370 DOI: 10.1146/annurev-med-121417-100403] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Given the increasing understanding of cancer as a heterogeneous group of diseases, detection methods should offer a sensitivity profile that ensures perfect sensitivity for biologically important cancers while screening out self-limiting pseudocancers. However, mammographic screening is biased toward detection of ductal carcinoma in situ and slowly growing cancers-and thus frequently fails to detect biologically aggressive cancers. This explains the persistently high rates of interval cancers and high rates of breast cancer mortality observed in spite of decades of mammographic screening. Magnetic resonance imaging (MRI), in contrast, has a sensitivity profile that matches clinical needs. Conventional MRI is not suitable for population-wide screening due to high cost, limited tolerability, and lack of availability. We introduced abbreviated MRI in 2014. Abbreviated MRI will change the way MRI is used in clinical medicine. This article describes the rationale to use MRI in general, and abbreviated MRI in particular, for breast cancer screening.
Collapse
Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University, 52074 Aachen, Germany;
| |
Collapse
|
165
|
Partovi S, Sin D, Lu Z, Sieck L, Marshall H, Pham R, Plecha D. Fast MRI breast cancer screening - Ready for prime time. Clin Imaging 2019; 60:160-168. [PMID: 31927171 DOI: 10.1016/j.clinimag.2019.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The manuscript discusses landmark studies using abbreviated MRI for breast cancer screening. This includes abbreviated dynamic contrast enhanced MRI and diffusion weighted imaging. Our institutional experience with abbreviated MR protocol for breast cancer screening is also described. CONCLUSION Abbreviated MRI protocols were found to demonstrate value for screening of breast cancer. It has been shown that abbreviated protocol MRI provides similar diagnostic sensitivities to full protocol MRI for breast cancer in women with increased lifetime risk. Our institutional abbreviated MRI protocol for breast cancer offers improved time and workflow efficiencies and has the potential to increase the number of breast cancers detected and the detection of pathologically relevant invasive breast cancer at earlier stages.
Collapse
Affiliation(s)
- Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America.
| | - David Sin
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America
| | - Ziang Lu
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Leah Sieck
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Holly Marshall
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Ramya Pham
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| | - Donna Plecha
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States of America
| |
Collapse
|
166
|
Brunsing RL, Chen DH, Schlein A, Wolfson T, Gamst A, Mamidipalli A, Violi NV, Marks RM, Taouli B, Loomba R, Kono Y, Sirlin CB. Gadoxetate-enhanced Abbreviated MRI for Hepatocellular Carcinoma Surveillance: Preliminary Experience. Radiol Imaging Cancer 2019; 1:e190010. [PMID: 33778680 DOI: 10.1148/rycan.2019190010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022]
Abstract
Purpose To describe a single-center preliminary experience with gadoxetate disodium-enhanced abbreviated MRI for hepatocellular carcinoma (HCC) screening and surveillance in patients with cirrhosis or chronic hepatitis B virus (cHBV). Materials and Methods This was a retrospective study of consecutive patients aged 18 years and older with cirrhosis or cHBV who underwent at least one gadoxetate-enhanced abbreviated MRI examination for HCC surveillance from 2014 through 2016. Examinations were interpreted prospectively by one of six abdominal radiologists for clinical care. Clinical, imaging, and other data were extracted from electronic medical records. Diagnostic adequacy was assessed in all patients. Diagnostic accuracy was assessed in the subset of patients who could be classified as having HCC or not having HCC on the basis of a composite reference standard. Results In this study, 330 patients (93% with cirrhosis; 45% women; mean age, 59 years) underwent gadoxetate-enhanced abbreviated MRI. In the 330 patients, 311 (94.2%) baseline gadoxetate-enhanced abbreviated MRI examinations were diagnostically adequate. Of 141 (43%) of the 330 patients, 91.4% (129 of 141) could be classified as not having HCC and 8.6% (12 of 141) could be classified as having HCC. Baseline gadoxetate-enhanced abbreviated MRI had 0.92 sensitivity (95% confidence interval [CI]: 0.62, 1.00) and 0.91 specificity (95% CI: 0.84, 0.95) for detection of HCC. Of the 330 patients who underwent baseline gadoxetate-enhanced abbreviated MRI, 187 (57%) were lost to follow-up. Conclusion Gadoxetate-enhanced abbreviated MRI is feasible clinically, has a high diagnostic adequacy rate, and, on the basis of our preliminary experience, accurately depicts HCC in high-risk patients. Strategies to enhance follow-up compliance are needed.© RSNA, 2019Keywords: Abdomen/GI, Cirrhosis, Liver, MR-Imaging, Oncology, ScreeningSupplemental material is available for this article.
Collapse
Affiliation(s)
- Ryan L Brunsing
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Dennis H Chen
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Alexandra Schlein
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Tanya Wolfson
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Anthony Gamst
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Adrija Mamidipalli
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Naik Vietti Violi
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Robert M Marks
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Bachir Taouli
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Rohit Loomba
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Yuko Kono
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.)
| |
Collapse
|
167
|
Bakker MF, de Lange SV, Pijnappel RM, Mann RM, Peeters PHM, Monninkhof EM, Emaus MJ, Loo CE, Bisschops RHC, Lobbes MBI, de Jong MDF, Duvivier KM, Veltman J, Karssemeijer N, de Koning HJ, van Diest PJ, Mali WPTM, van den Bosch MAAJ, Veldhuis WB, van Gils CH. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med 2019; 381:2091-2102. [PMID: 31774954 DOI: 10.1056/nejmoa1903986] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients. METHODS In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period. RESULTS The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening. CONCLUSIONS The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period. (Funded by the University Medical Center Utrecht and others; DENSE ClinicalTrials.gov number, NCT01315015.).
Collapse
Affiliation(s)
- Marije F Bakker
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Stéphanie V de Lange
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Ruud M Pijnappel
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Ritse M Mann
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Petra H M Peeters
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Evelyn M Monninkhof
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Marleen J Emaus
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Claudette E Loo
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Robertus H C Bisschops
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Marc B I Lobbes
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Matthijn D F de Jong
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Katya M Duvivier
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Jeroen Veltman
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Nico Karssemeijer
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Harry J de Koning
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Paul J van Diest
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Willem P T M Mali
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Maurice A A J van den Bosch
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Wouter B Veldhuis
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Carla H van Gils
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| |
Collapse
|
168
|
Jones LI, Geach R, Harding SA, Foy C, Taylor V, Marshall A, Taylor-Phillips S, Dunn JA. Can mammogram readers swiftly and effectively learn to interpret first post-contrast acquisition subtracted (FAST) MRI, a type of abbreviated breast MRI?: a single centre data-interpretation study. Br J Radiol 2019; 92:20190663. [PMID: 31559859 DOI: 10.1259/bjr.20190663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess whether NHS breast screening programme (NHSBSP) mammogram readers could effectively interpret first post-contrast acquisition subtracted (FAST) MRI, for intended use in screening for breast cancer. METHODS Eight NHSBSP mammogram readers from a single centre (four who also read breast MRI (Group 1) and four who do not (Group 2)) were given structured FAST MRI reader training (median 4 h: 32 min). They then prospectively interpreted 125 FAST MRIs (250 breasts: 194 normal and 56 cancer) comprising a consecutive series of screening MRIs enriched with additional cancer cases from 2015, providing 2000 interpretations. Readers were blinded to other readers' opinions and to clinical information. Categorisation followed the NHSBSP MRI reporting categorisation, with categories 4 and 5 considered indicative of cancer. Diagnostic accuracy (reference standard: histology or 2 years' follow-up) and agreement between readers were determined. RESULTS The accuracy achieved by Group 2 (847/1000 (85%; 95% confidence interval (CI) 82-87%)) was 5% less than that of Group 1 (898/1000 (90%; 95% CI 88-92)). Good inter-reader agreement was seen between both Group 1 readers (κ = 0.66; 95% CI 0.61-0.71) and Group 2 readers (κ = 0.63; 95% CI 0.58-0.68). The median time taken to interpret each FAST MRI was Group 1: 34 s (range 3-351) and Group 2: 77 s (range 11-321). CONCLUSION Brief structured training enabled multiprofessional mammogram readers to achieve similar accuracy at FAST MRI interpretation to consultant radiologists experienced at breast MRI interpretation. ADVANCES IN KNOWLEDGE FAST MRI could be feasible from a training-the-workforce perspective for screening within NHSBSP.
Collapse
Affiliation(s)
- Lyn I Jones
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol BS10 5NB, UK
| | - Rebecca Geach
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol BS10 5NB, UK
| | - Sam A Harding
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol BS10 5NB, UK
| | - Christopher Foy
- Research Design Service South West Gloucester Office, National Institute for Health Research (NIHR) Leadon House, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | - Victoria Taylor
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol BS10 5NB, UK
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | | | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| |
Collapse
|
169
|
|
170
|
Saadatmand S, Geuzinge HA, Rutgers EJT, Mann RM, de Roy van Zuidewijn DBW, Zonderland HM, Tollenaar RAEM, Lobbes MBI, Ausems MGEM, van 't Riet M, Hooning MJ, Mares-Engelberts I, Luiten EJT, Heijnsdijk EAM, Verhoef C, Karssemeijer N, Oosterwijk JC, Obdeijn IM, de Koning HJ, Tilanus-Linthorst MMA, van Deurzen CHM, Loo CE, Wesseling J, Schlooz-Vries M, van der Meij S, Mesker W, Keymeulen K, Contant C, Madsen E, Koppert LB, Rothbarth J, Veldhuis WB, Witkamp AJ, Tetteroo E, de Monye C, van Rosmalen MM, Remmelzwaal J, Gort HBW, Roi-Antonides R, Wasser MNJM, van Druten E. MRI versus mammography for breast cancer screening in women with familial risk (FaMRIsc): a multicentre, randomised, controlled trial. Lancet Oncol 2019; 20:1136-1147. [DOI: 10.1016/s1470-2045(19)30275-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/03/2023]
|
171
|
Borthakur A, Weinstein SP, Schnall MD, Conant EF. Comparison of Study Activity Times for “Full” versus “Fast MRI” for Breast Cancer Screening. J Am Coll Radiol 2019; 16:1046-1051. [DOI: 10.1016/j.jacr.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 01/27/2023]
|
172
|
Implementing Abbreviated MRI Screening Into a Breast Imaging Practice. AJR Am J Roentgenol 2019; 213:234-237. [DOI: 10.2214/ajr.18.20396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
173
|
Melsaether AN, Kim E, Mema E, Babb J, Kim SG. Preliminary study: Breast cancers can be well seen on 3T breast MRI with a half-dose of gadobutrol. Clin Imaging 2019; 58:84-89. [PMID: 31279989 DOI: 10.1016/j.clinimag.2019.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dynamic contrast enhanced (DCE) breast MRI is highly sensitive for breast cancer and requires gadolinium-based contrast agents (GBCA)s, which have potential safety concerns. PURPOSE Test whether breast cancers imaged by 3T DCE breast MRI with 0.05 mmol/kg of gadobutrol are detectable. METHODS Analysis of 3T DCE breast MRIs with half dose of gadobutrol from patients included in an IRB-approved and HIPPA-compliant prospective study of breast PET/MRI. Between 11/7/2014 and 3/2/2018, 41 consecutive women with biopsy-proven breast cancer that was at least 2 cm, multi-focal or multi-centric, had axillary metastasis, or had skin involvement who gave informed consent were included. Two breast radiologists independently recorded lesion conspicuity on a 4-point scale (0 = not seen, 1 = questionably seen, 2 = adequately seen, 3 = certainly seen), and measured the lesion. Size was compared between radiologists and with size on available mammogram, ultrasound, MRI, and surgical pathology. Inter-reader agreement was assessed by kappa coefficient for conspicuity. Lesion size comparisons were assessed using the Spearman rank correlation. RESULTS In 40 patients (ages 28.4-80.5, 51.9 years), there were 49 cancers. 10.1% of lesions were 1 cm or less and 26.5% of lesions were 2 cm or less. Each reader detected 49/49 cancers. Conspicuity scores ranged from 2 to 3, mean 2.9/3 for both readers (p = 0.47). Size on half-dose 3T DCE-MRI correlated with size on surgical pathology (r = 0.6, p = 0.03) while size on mammogram and ultrasound did not (r = 0.25, p = 0.46; r = 0.25, p = 0.42). CONCLUSION All breast cancers in this cohort, as small as 0.4 cm, were seen on 3T DCE breast MRI with 0.05 mmol/kg dose of gadobutrol.
Collapse
Affiliation(s)
- Amy N Melsaether
- Department of Radiology, NYU School of Medicine, 160 E34th St, 3rd Floor, New York, NY 10016, United States of America.
| | - Eric Kim
- Department of Radiology, NYU School of Medicine, 160 E34th St, 3rd Floor, New York, NY 10016, United States of America.
| | - Eralda Mema
- Department of Radiology, NYU School of Medicine, 160 E34th St, 3rd Floor, New York, NY 10016, United States of America.
| | - James Babb
- NYU School of Medicine and Center for Advanced Imaging and Innovation, (CAI2R), NYU School of Medicine, 660 1st Ave, 2nd Floor, New York, NY 10016, United States of America.
| | - Sungheon Gene Kim
- NYU School of Medicine and Center for Advanced Imaging and Innovation, (CAI2R), NYU School of Medicine, 660 1st Ave, 2nd Floor, New York, NY 10016, United States of America; Bernard and Irene Schwartz Center for Biomedical Imaging Department of Radiology, NYU School of Medicine, 660 1st Ave, 2nd Floor, New York, NY 10016, United States of America.
| |
Collapse
|
174
|
Honda M, Kataoka M, Onishi N, Iima M, Ohashi A, Kanao S, Nickel MD, Toi M, Togashi K. New parameters of ultrafast dynamic contrast-enhanced breast MRI using compressed sensing. J Magn Reson Imaging 2019; 51:164-174. [PMID: 31215107 DOI: 10.1002/jmri.26838] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ultrafast dynamic contrast-enhanced (UF-DCE) breast MRI is considered a promising method of accelerated breast MRI. However, the value of new kinetic parameters derived from UF-DCE need clinical evaluation. PURPOSE To evaluate the diagnostic performance of the maximum slope (MS), time to enhancement (TTE), and time interval between arterial and venous visualization (AVI) derived from UF-DCE MRI using compressed sensing (CS). STUDY TYPE Retrospective. POPULATION Seventy-five patients with histologically proven breast lesions. The total number of analyzed lesions was 90 (61 malignant and 29 benign). FIELD STRENGTH/SEQUENCE 3T MRI with UF-DCE MRI based on the 3D gradient-echo volumetric interpolated breath-hold examination (VIBE) sequence using incoherent k-space sampling combined with a CS reconstruction followed by conventional DCE MRI. ASSESSMENT The diagnostic performance of the MS, TTE, AVI, and conventional kinetic analysis was analyzed and compared with histology. STATISTICAL TESTS Wilcoxon rank sum test, receiver operating characteristic analysis. RESULTS The MS was larger and the TTE and AVI were smaller for malignant lesions compared with benign lesions: MS: 29.3%/s and 18.4%/s (P < 0.001), TTE: 7.0 and 12.0 seconds (P < 0.001), AVI: 2.7 and 4.4 frames (P = 0.006) for malignant and benign lesions. The discriminating power of the MS (area under the curve [AUC], 0.76) was slightly better than that of conventional kinetic analysis (AUC, 0.69) and comparable to that of the TTE and AVI (AUC, 0.78 and 0.76 for TTE and AVI, respectively). Invasive lobular carcinoma had smaller MS (21.8%/s) among malignant lesions (29.3%/s). DATA CONCLUSION The MS, TTE, and AVI can be used to evaluate breast lesions with clinical performance equivalent to that of conventional kinetic analysis. These parameters vary among histologies. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:164-174.
Collapse
Affiliation(s)
- Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuko Onishi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shotaro Kanao
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
175
|
Underdiagnosis is the main challenge in breast cancer screening. Lancet Oncol 2019; 20:1044-1046. [PMID: 31221618 DOI: 10.1016/s1470-2045(19)30314-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/23/2022]
|
176
|
Hollingsworth AB, Pearce MR, Stough RG. Modeling the impact of a screening blood test on the use of adjunct breast imaging. Breast J 2019; 25:1045-1046. [PMID: 31172623 DOI: 10.1111/tbj.13397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Melanie R Pearce
- Department of Radiology, Mercy Hospital, Oklahoma City, Oklahoma
| | - Rebecca G Stough
- Department of Radiology, Mercy Hospital, Oklahoma City, Oklahoma
| |
Collapse
|
177
|
Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screening. Invest Radiol 2019; 53:579-586. [PMID: 29944483 DOI: 10.1097/rli.0000000000000494] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP). MATERIALS AND METHODS The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions. RESULTS For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90) versus 0.84 (95% CI, 0.78-0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74-0.79) versus 0.82 (95% CI, 0.79-0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36-0.45) versus 0.45 (95% CI, 0.41-0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82-0.96) versus 0.89 (95% CI, 0.82-0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P < 0.001). Interreader agreement is significantly better for ultrafast breast MRI (κ = 0.730; 95% CI, 0.699-0.761) than for the FDP (κ = 0.665; 95% CI, 0.633-0.696). CONCLUSIONS Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
Collapse
|
178
|
Diffusion-Weighted Imaging With Apparent Diffusion Coefficient Mapping for Breast Cancer Detection as a Stand-Alone Parameter: Comparison With Dynamic Contrast-Enhanced and Multiparametric Magnetic Resonance Imaging. Invest Radiol 2019; 53:587-595. [PMID: 29620604 DOI: 10.1097/rli.0000000000000465] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aims of this study were to compare dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) with apparent diffusion coefficient mapping as a stand-alone parameter without any other supportive sequence for breast cancer detection and to assess its combination as multiparametric MRI (mpMRI) of the breast. MATERIALS AND METHODS In this institutional review board-approved single-center study, prospectively acquired data of 106 patients who underwent breast MRI from 12/2010 to 09/2014 for an imaging abnormality (Breast Imaging Reporting and Data System 0, 4/5) were retrospectively analyzed. Four readers independently assessed DWI and DCE as well as combined as mpMRI. Breast Imaging Reporting and Data System categories, lesion size, and mean apparent diffusion coefficient values were recorded. Histopathology was used as the gold standard. Appropriate statistical tests were used to compare diagnostic values. RESULTS There were 69 malignant and 41 benign tumors in 106 patients. Four patients presented with bilateral lesions. Dynamic contrast-enhanced MRI was the most sensitive test for breast cancer detection, with an average sensitivity of 100%. Diffusion-weighted imaging alone was less sensitive (82%; P < 0.001) but more specific than DCE-MRI (86.8% vs 76.6%; P = 0.002). Diagnostic accuracy was 83.7% for DWI and 90.6% for DCE-MRI. Multiparametric MRI achieved a sensitivity of 96.8%, not statistically different from DCE-MRI (P = 0.12) and with a similar specificity as DWI (83.8%; P = 0.195), maximizing diagnostic accuracy to 91.9%. There was almost perfect interreader agreement for DWI (κ = 0.864) and DCE-MRI (κ = 0.875) for differentiation of benign and malignant lesions. CONCLUSION Dynamic contrast-enhanced MRI is most sensitive for breast cancer detection and thus still indispensable. Multiparametric MRI using DCE-MRI and DWI maintains a high sensitivity, increases specificity, and maximizes diagnostic accuracy, often preventing unnecessary breast biopsies. Diffusion-weighted imaging should not be used as a stand-alone parameter because it detects significantly fewer cancers in comparison with DCE-MRI and mpMRI.
Collapse
|
179
|
Wei D, Weinstein S, Hsieh MK, Pantalone L, Kontos D. Three-Dimensional Whole Breast Segmentation in Sagittal and Axial Breast MRI With Dense Depth Field Modeling and Localized Self-Adaptation for Chest-Wall Line Detection. IEEE Trans Biomed Eng 2019; 66:1567-1579. [PMID: 30334748 PMCID: PMC6684022 DOI: 10.1109/tbme.2018.2875955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Whole breast segmentation is an essential task in quantitative analysis of breast MRI for cancer risk assessment. It is challenging, mainly, because the chest-wall line (CWL) can be very difficult to locate due to its spatially varying appearance-caused by both nature and imaging artifacts-and neighboring distracting structures. This paper proposes an automatic three-dimensional (3-D) segmentation method, termed DeepSeA, of whole breast for breast MRI. METHODS DeepSeA distinguishes itself from previous methods in three aspects. First, it reformulates the challenging problem of CWL localization as an equivalent problem that optimizes a smooth depth field and so fully utilizes the CWL's 3-D continuity. Second, it employs a localized self-adapting algorithm to adjust to the CWL's spatial variation. Third, it applies to breast MRI data in both sagittal and axial orientations equally well without training. RESULTS A representative set of 99 breast MRI scans with varying imaging protocols is used for evaluation. Experimental results with expert-outlined reference standard show that DeepSeA can segment breasts accurately: the average Dice similarity coefficients, sensitivity, specificity, and CWL deviation error are 96.04%, 97.27%, 98.77%, and 1.63 mm, respectively. In addition, the configuration of DeepSeA is generalized based on experimental findings, for application to broad prospective data. CONCLUSION A fully automatic method-DeepSeA-for whole breast segmentation in sagittal and axial breast MRI is reported. SIGNIFICANCE DeepSeA can facilitate cancer risk assessment with breast MRI.
Collapse
Affiliation(s)
- Dong Wei
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Susan Weinstein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Meng-Kang Hsieh
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lauren Pantalone
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Despina Kontos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
180
|
Mango VL, Goel A, Mema E, Kwak E, Ha R. Breast MRI screening for average-risk women: A monte carlo simulation cost-benefit analysis. J Magn Reson Imaging 2019; 49:e216-e221. [PMID: 30632645 PMCID: PMC7478848 DOI: 10.1002/jmri.26334] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Screening high-risk women for breast cancer with MRI is cost-effective, with increasing cost-effectiveness paralleling increasing risk. However, for average-risk women cost is considered a major limitation to mass screening with MRI. PURPOSE To perform a cost-benefit analysis of a simulated breast cancer screening program for average-risk women comparing MRI with mammography. STUDY TYPE Population simulation study. POPULATION/SUBJECTS Five million (M) hypothetical women undergoing breast cancer screening. FIELD STRENGTH/SEQUENCE Simulation based primarily on Kuhl et al8 study utilizing 1.5T MRI with an axial bilateral 2D multisection gradient-echo dynamic series (repetition time / echo time 250/4.6 msec; flip angle, 90°) with a full 512 × 512 acquisition matrix and a sensitivity encoding factor of two, performed prior to and four times after bolus injection of 0.1 mmol of gadobutrol per kg of body weight (Gadovist; Bayer, Germany). An axial T2 -weighted fast spin-echo sequence with identical anatomic parameters was also included. ASSESSMENT A Monte Carlo simulation utilizing Medicare reimbursement rates to calculate input variable costs was developed to compare 5M women undergoing breast cancer screening with either triennial MRI or annual mammography, 2.5M in each group, over 30 years. STATISTICAL TESTS Expected recall rates, BI-RADS 3, BI-RADS 4/5 cases and cancer detection rates were determined from published literature with calculated aggregate costs including resultant diagnostic/follow-up imaging and biopsies. RESULTS Baseline screening of 2.5M women with breast MRI cost $1.6 billion (B), 3× higher than baseline mammography screening ($0.54B). With subsequent screening, MRI screening is more cost-effective than mammography screening in 24 years ($13.02B vs. $13.03B). MRI screening program costs are largely driven by cost per MRI exam ($549.71). A second simulation model was performed based on MRI Medicare reimbursement trends using a lower MRI cost ($400). This yielded a cost-effective benefit compared to mammography screening in less than 6 years ($3.41B vs. $3.65B), with over a 22% cost reduction relative to mammography screening in 12 years and reaching a 38% reduction in 30 years. DATA CONCLUSION Despite higher initial cost of a breast MRI screening program for average-risk women, there is ultimately a cost savings over time compared with mammography. This estimate is conservative given cost-benefit of additional/earlier breast cancers detected by breast MRI were not accounted for. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.
Collapse
Affiliation(s)
- Victoria L. Mango
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Akshay Goel
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Eralda Mema
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Ellie Kwak
- Department of Radiology, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Richard Ha
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
181
|
Arıbal E, Buğdaycı O. Supplementary abbreviated supine breast MRI following a standard prone breast MRI with single contrast administration: is it effective in detecting the initial contrast-enhancing lesions? ACTA ACUST UNITED AC 2019; 25:265-269. [PMID: 31124788 DOI: 10.5152/dir.2019.18167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We aimed to evaluate the detectability of contrast enhancing lesions, initially demonstrated in standard prone dynamic contrast-enhanced MRI (DCE-MRI), in a supplementary supine breast MRI examination performed following the standard prone DCE-MRI examination and to show the correlation of spatial displacement of the lesions with breast size and density. METHODS Forty-two patients with 45 lesions were prospectively evaluated. Supine breast MRI was acquired with a 6-channel body coil following a standard DCE-MRI in prone position after repositioning the patient. No additional contrast media was administered. Images were evaluated by two radiologists in consensus for the visibility of the lesions. Lesion localization relative to the sternal midline, chest wall and nipple was measured in both prone and supine positions. Correlations between lesion displacement and breast size or breast density were analyzed. RESULTS Of 45 lesions, 23 (52.3%) were masses, 22 (47.7%) were nonmass enhancements (NME). Forty-four lesions (97.8%) could be detected on supine images. One linear NME of 33 mm in length could not be seen on supine images. Twenty (46.5%) of the detected lesions in supine position were equal to or smaller than 10 mm (11 NME [55%] and 9 masses [45%]). Lesion displacement relative to the chest wall increased with increasing breast size (P < 0.001). CONCLUSION An abbreviated supine sequence following a standard prone DCE-MRI with single contrast media administration is an effective method for defining the lesion location in supine position.
Collapse
Affiliation(s)
- Erkin Arıbal
- Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey; Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Onur Buğdaycı
- Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey; Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| |
Collapse
|
182
|
Hellgren RJ, Sundbom AE, Czene K, Izhaky D, Hall P, Dickman PW. Does three-dimensional functional infrared imaging improve breast cancer detection based on digital mammography in women with dense breasts? Eur Radiol 2019; 29:6227-6235. [PMID: 31115623 PMCID: PMC6795638 DOI: 10.1007/s00330-019-06248-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/30/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
Purpose We aimed to estimate the incremental cancer detection rate achieved by adding three-dimensional functional infrared imaging (3DIRI) to digital mammography in women with dense breasts. Materials and methods In this prospective study conducted between December 2014 and April 2016, 1727 women (median age 56) with percentage volumetric breast density > 6% were recruited at routine screening mammography to undergo additional 3DIRI. The 3DIRI findings were classified as negative or positive. Women with a negative mammography but positive 3DIRI were referred to dynamic contrast-enhanced MRI, whereas all other women underwent routine follow-up based on the mammography finding. Diagnosis of breast cancer was verified by histopathologic examination. The number of women diagnosed with a malignancy formed the basis of our statistical analysis. Results Mammography detected 7 cancers in 7 women. Of 1692 women with negative mammography, 222 women (13%) had a positive 3DIRI of which 219 underwent MRI. An additional 6 cancers were identified in 5 women, increasing the diagnostic yield from 7 of 1727 (0.41%) to 12 of 1727 (0.69%). The incremental cancer detection rate associated with using 3DIRI to select women for MRI was 5 of 222 (22.5 additional cancers per 1000). Conclusion The use of 3DIRI to select women for an additional MRI can result in the detection of additional cancers in women with dense breasts, but at the expense of additional false positives and considerably lower positive predictive value of the combined examinations. Additional studies are necessary to evaluate the role of 3DIRI as an adjunct to mammography. Key Points • Use of three-dimensional functional infrared imaging to select women for an MRI in addition to screening mammography has the potential to improve breast cancer detection in women with dense breasts. Electronic supplementary material The online version of this article (10.1007/s00330-019-06248-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Roxanna J Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, 118 83, Stockholm, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Ann E Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - David Izhaky
- Department of Research and Development, Real Imaging, 1 Golan St., 7019802, Airport City, Israel
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| |
Collapse
|
183
|
Vourtsis A, Berg WA. Breast density implications and supplemental screening. Eur Radiol 2019; 29:1762-1777. [PMID: 30255244 PMCID: PMC6420861 DOI: 10.1007/s00330-018-5668-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/21/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
Digital breast tomosynthesis (DBT) has been widely implemented in place of 2D mammography, although it is less effective in women with extremely dense breasts. Breast ultrasound detects additional early-stage, invasive breast cancers when combined with mammography; however, its relevant limitations, including the shortage of trained operators, operator dependence and small field of view, have limited its widespread implementation. Automated breast sonography (ABS) is a promising technique but the time to interpret and false-positive rates need to be improved. Supplemental screening with contrast-enhanced magnetic resonance imaging (MRI) in high-risk women reduces late-stage disease; abbreviated MRI protocols may reduce cost and increase accessibility to women of average risk with dense breasts. Contrast-enhanced digital mammography (CEDM) and molecular breast imaging improve cancer detection but require further validation for screening and direct biopsy guidance should be implemented for any screening modality. This article reviews the status of screening women with dense breasts. KEY POINTS: • The sensitivity of mammography is reduced in women with dense breasts. Supplemental screening with US detects early-stage, invasive breast cancers. • Tomosynthesis reduces recall rate and increases cancer detection rate but is less effective in women with extremely dense breasts. • Screening MRI improves early diagnosis of breast cancer more than ultrasound and is currently recommended for women at high risk. Risk assessment is needed, to include breast density, to ascertain who should start early annual MRI screening.
Collapse
Affiliation(s)
- Athina Vourtsis
- "Diagnostic Mammography", Medical Diagnostic Imaging Unit, Founding President of the Hellenic Breast Imaging Society, Kifisias Ave 362, Chalandri, 15233, Athens, Greece.
| | - Wendie A Berg
- Department of Radiology, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
184
|
Busch SH, Hoag JR, Aminawung JA, Xu X, Richman IB, Soulos PR, Kyanko KA, Gross CP. Association of State Dense Breast Notification Laws With Supplemental Testing and Cancer Detection After Screening Mammography. Am J Public Health 2019; 109:762-767. [PMID: 30896987 DOI: 10.2105/ajph.2019.304967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the association of state dense breast notification (DBN) laws with use of supplemental tests and cancer diagnosis after screening mammography. METHODS We examined screening mammograms (n = 1 441 544) performed in 2014 and 2015 among privately insured women aged 40 to 59 years living in 9 US states that enacted DBN laws in 2014 to 2015 and 25 US states with no DBN law in effect. DBN status at screening mammography was categorized as no DBN, generic DBN, and DBN that mandates notification of possible benefits of supplemental screening (DBN+SS). We used logistic regression to examine the change in rate of supplemental ultrasound, magnetic resonance imaging, breast biopsy, and breast cancer detection. RESULTS DBN+SS laws were associated with 10.5 more ultrasounds per 1000 mammograms (95% CI = 3.0, 17.6 per 1000; P = .006) and 0.37 more breast cancers detected per 1000 mammograms (95% CI = 0.05, 0.69 per 1000; P = .02) compared with no DBN law. No significant differences were found for generic DBN laws in either ultrasound or cancer detection. CONCLUSIONS DBN legislation is associated with increased use of ultrasound and cancer detection after implementation only when notification of the possible benefits of supplemental screening is required.
Collapse
Affiliation(s)
- Susan H Busch
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Jessica R Hoag
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Jenerius A Aminawung
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Xiao Xu
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Ilana B Richman
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Pamela R Soulos
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Kelly A Kyanko
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Cary P Gross
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| |
Collapse
|
185
|
Pu H, Zhang XL, Xiang LH, Zhang JL, Xu G, Liu H, Tang GY, Zhao BH, Wu R. The efficacy of added shear wave elastography (SWE) in breast screening for women with inconsistent mammography and conventional ultrasounds (US). Clin Hemorheol Microcirc 2019; 71:83-94. [PMID: 29843228 DOI: 10.3233/ch-180398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xue-Li Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Jiu-Long Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang-Yu Tang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bing-Hui Zhao
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
186
|
Mouawad M, Biernaski H, Brackstone M, Lock M, Yaremko B, Sexton T, Yu E, Dinniwell RE, Lynn K, Hajdok G, Prato FS, Thompson RT, Gelman N, Gaede S. Reducing the dose of gadolinium-based contrast agents for DCE-MRI guided SBRT: The effects on inter and intra observer variability for preoperative target volume delineation in early stage breast cancer patients. Radiother Oncol 2019; 131:60-65. [PMID: 30773188 DOI: 10.1016/j.radonc.2018.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/26/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the effects of reducing the dose of contrast agent (CA) in a DCE-MRI scan on inter- and intra-observer variability in the context of MRI-guided target volume delineation for stereotactic body radiation therapy of early stage breast cancer patients. This is in hopes of reducing risks to patients due to findings of residual CA in brain and bone. MATERIALS AND METHODS Twenty-three patients receiving neoadjuvant radiation therapy were enrolled. Five observers delineated the gross target volume (GTV) using DCE-MRI for guidance. 14/23 patients received the full clinical dose of CA and 9/23 received half. Clinical target volumes (CTV) were created through a 0.5 cm uniform expansion. Several metrics were used to quantify the inter and intra-observer reliability including differences in delineation volume and the reliability coefficient. RESULTS There were no significant differences in the volume, though half contrast patients had a lower median for both the GTV and CTV (difference of 0.26 cm3 and 1.27 cm3, respectively). All indicated a high degree of agreement between and within observers for both dose groups. However, the full dose group had a greater inter-observer variability, most likely due to the full CA causing more pronounced enhancement in the periphery. CONCLUSIONS Reducing the dose of contrast agent did not significantly alter inter- or intra-observer variability. These results have prompted our centre to reduce the dose of gadolinium in all patients enrolled in the SIGNAL trial.
Collapse
Affiliation(s)
| | | | - Muriel Brackstone
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada; London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Michael Lock
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Brian Yaremko
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Tracy Sexton
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Edward Yu
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Robert E Dinniwell
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Kalan Lynn
- London Health Sciences Centre, London, Canada.
| | | | - Frank S Prato
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Robert Terry Thompson
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Neil Gelman
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Stewart Gaede
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada; London Health Sciences Centre, London, Canada.
| |
Collapse
|
187
|
Brown AL, Phillips J, Mehta TS, Brook A, Sharpe RE, Slanetz PJ, Dialani V. Breast MRI ordering practices in a large health care network. Breast J 2019; 25:262-268. [DOI: 10.1111/tbj.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ann L. Brown
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Division of Breast Imaging; Department of Radiology; University of Cincinnati Medical Center and College of Medicine; Cincinnati OH USA
| | - Jordana Phillips
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Tejas S. Mehta
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Alexander Brook
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Richard E. Sharpe
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Colorado Permanente Medical Group; Kaiser Permanente; Denver CO USA
| | - Priscilla J. Slanetz
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Vandana Dialani
- Division of Breast Imaging; Department of Radiology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| |
Collapse
|
188
|
Hollingsworth AB. Redefining the sensitivity of screening mammography: A review. Am J Surg 2019; 218:411-418. [PMID: 30739738 DOI: 10.1016/j.amjsurg.2019.01.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022]
Abstract
From its inception, screening mammography has enjoyed a perceived level of sensitivity that is inconsistent with available evidence. The original data that imparted erroneous beliefs about sensitivity were based on a variety of misleading definitions and approaches, such as the inclusion of palpable tumors, using the inverse of interval cancer rates (often tied to an arbitrary 12 month interval), and quoting prevalence screen sensitivity wherein tumors are larger than those found on incidence screens. This review addresses the background for the overestimation of mammographic sensitivity, and how a major adjustment in our thinking is overdue now that multi-modality imaging allows us to determine real time mammographic sensitivity. Although a single value for mammographic sensitivity is disingenuous, given the wide range based on background density, it is important to realize that a sensitivity gap between belief and reality still exists in the early detection of breast cancer using mammography alone, in spite of technologic advances. Failure to recognize this gap diminishes the acceptance of adjunct methods of breast imaging that greatly complement detection rates.
Collapse
Affiliation(s)
- Alan B Hollingsworth
- Department of Surgery, Mercy Hospital, 4401 W. McAuley Blvd., Suite #1100, Mercy Hospital Coletta Building, Oklahoma City, OK, USA.
| |
Collapse
|
189
|
|
190
|
Mann RM, Kuhl CK, Moy L. Contrast-enhanced MRI for breast cancer screening. J Magn Reson Imaging 2019; 50:377-390. [PMID: 30659696 PMCID: PMC6767440 DOI: 10.1002/jmri.26654] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/15/2022] Open
Abstract
Multiple studies in the first decade of the 21st century have established contrast-enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow-up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage-shift increasing the survival benefit of screening. Cost-effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:377-390.
Collapse
Affiliation(s)
- Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Radiology, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, Aachen, Germany
| | - Linda Moy
- Center for Advanced Imaging Innovation and Research / Department of Radiology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
191
|
Mootz AR, Madhuranthakam AJ, Doğan B. Changing Paradigms in Breast Cancer Screening: Abbreviated Breast MRI. Eur J Breast Health 2019; 15:1-6. [PMID: 30816364 DOI: 10.5152/ejbh.2018.4402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/02/2018] [Indexed: 01/07/2023]
Abstract
Breast magnetic resonance imaging (MRI) is the most sensitive imaging method for breast cancer detection. In this review we discuss the vastly superior performance of MRI compared to traditional breast cancer screening modalities of mammography, tomosynthesis and ultrasound. We discuss an abbreviated breast MRI (AB-MRI) protocol utilizing Dixon sequences which is compliant with American College of Radiology (ACR) guidelines for accreditation of breast MRI but with significantly reduced scan times. Adaptation of such an AB-MRI protocol significantly increases patient throughput and may allow MRI to serve as a stand- alone breast cancer screening tool.
Collapse
Affiliation(s)
- Ann R Mootz
- Department of Radiology, University of Texas Southwestern Medical School, Texas, USA
| | | | - Başak Doğan
- Department of Radiology, University of Texas Southwestern Medical School, Texas, USA
| |
Collapse
|
192
|
Gao Y, Brachtel EF, Hernandez O, Heller SL. An Analysis of Nipple Enhancement at Breast MRI with Radiologic-Pathologic Correlation. Radiographics 2019; 39:10-27. [DOI: 10.1148/rg.2019180039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yiming Gao
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Elena F. Brachtel
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Osvaldo Hernandez
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| | - Samantha L. Heller
- From the Departments of Radiology (Y.G., S.L.H.) and Pathology (O.H.), New York University Langone Medical Center, 160 E 34th St, New York, NY 10016; and Department of Pathology, Massachusetts General Hospital, Boston, Mass (E.F.B.)
| |
Collapse
|
193
|
Truhn D, Schrading S, Haarburger C, Schneider H, Merhof D, Kuhl C. Radiomic versus Convolutional Neural Networks Analysis for Classification of Contrast-enhancing Lesions at Multiparametric Breast MRI. Radiology 2018; 290:290-297. [PMID: 30422086 DOI: 10.1148/radiol.2018181352] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose To compare the diagnostic performance of radiomic analysis (RA) and a convolutional neural network (CNN) to radiologists for classification of contrast agent-enhancing lesions as benign or malignant at multiparametric breast MRI. Materials and Methods Between August 2011 and August 2015, 447 patients with 1294 enhancing lesions (787 malignant, 507 benign; median size, 15 mm ± 20) were evaluated. Lesions were manually segmented by one breast radiologist. RA was performed by using L1 regularization and principal component analysis. CNN used a deep residual neural network with 34 layers. All algorithms were also retrained on half the number of lesions (n = 647). Machine interpretations were compared with prospective interpretations by three breast radiologists. Standard of reference was histologic analysis or follow-up. Areas under the receiver operating curve (AUCs) were used to compare diagnostic performance. Results CNN trained on the full cohort was superior to training on the half-size cohort (AUC, 0.88 vs 0.83, respectively; P = .01), but there was no difference for RA and L1 regularization (AUC, 0.81 vs 0.80, respectively; P = .76) or RA and principal component analysis (AUC, 0.78 vs 0.78, respectively; P = .93). By using the full cohort, CNN performance (AUC, 0.88; 95% confidence interval: 0.86, 0.89) was better than RA and L1 regularization (AUC, 0.81; 95% confidence interval: 0.79, 0.83; P < .001) and RA and principal component analysis (AUC, 0.78; 95% confidence interval: 0.76, 0.80; P < .001). However, CNN was inferior to breast radiologist interpretation (AUC, 0.98; 95% confidence interval: 0.96, 0.99; P < .001). Conclusion A convolutional neural network was superior to radiomic analysis for classification of enhancing lesions as benign or malignant at multiparametric breast MRI. Both approaches were inferior to radiologists' performance; however, more training data will further improve performance of convolutional neural network, but not that of radiomics algorithms. © RSNA, 2018 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Daniel Truhn
- From the Departments of Diagnostic and Interventional Radiology (D.T., S.S., H.S., C.K.) and Institute of Imaging and Computer Vision (C.H., D.M.), RWTH Aachen University, Aachen, Pauwelsstr 30, 52074 Aachen, Germany
| | - Simone Schrading
- From the Departments of Diagnostic and Interventional Radiology (D.T., S.S., H.S., C.K.) and Institute of Imaging and Computer Vision (C.H., D.M.), RWTH Aachen University, Aachen, Pauwelsstr 30, 52074 Aachen, Germany
| | - Christoph Haarburger
- From the Departments of Diagnostic and Interventional Radiology (D.T., S.S., H.S., C.K.) and Institute of Imaging and Computer Vision (C.H., D.M.), RWTH Aachen University, Aachen, Pauwelsstr 30, 52074 Aachen, Germany
| | - Hannah Schneider
- From the Departments of Diagnostic and Interventional Radiology (D.T., S.S., H.S., C.K.) and Institute of Imaging and Computer Vision (C.H., D.M.), RWTH Aachen University, Aachen, Pauwelsstr 30, 52074 Aachen, Germany
| | - Dorit Merhof
- From the Departments of Diagnostic and Interventional Radiology (D.T., S.S., H.S., C.K.) and Institute of Imaging and Computer Vision (C.H., D.M.), RWTH Aachen University, Aachen, Pauwelsstr 30, 52074 Aachen, Germany
| | - Christiane Kuhl
- From the Departments of Diagnostic and Interventional Radiology (D.T., S.S., H.S., C.K.) and Institute of Imaging and Computer Vision (C.H., D.M.), RWTH Aachen University, Aachen, Pauwelsstr 30, 52074 Aachen, Germany
| |
Collapse
|
194
|
Zhang M, Horvat JV, Bernard-Davila B, Marino MA, Leithner D, Ochoa-Albiztegui RE, Helbich TH, Morris EA, Thakur S, Pinker K. Multiparametric MRI model with dynamic contrast-enhanced and diffusion-weighted imaging enables breast cancer diagnosis with high accuracy. J Magn Reson Imaging 2018; 49:864-874. [PMID: 30375702 PMCID: PMC6375760 DOI: 10.1002/jmri.26285] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/24/2022] Open
Abstract
Background The MRI Breast Imaging‐Reporting and Data System (BI‐RADS) lexicon recommends that a breast MRI protocol contain T2‐weighted and dynamic contrast‐enhanced (DCE) MRI sequences. The addition of diffusion‐weighted imaging (DWI) significantly improves diagnostic accuracy. This study aims to clarify which descriptors from DCE‐MRI, DWI, and T2‐weighted imaging are most strongly associated with a breast cancer diagnosis. Purpose/Hypothesis To develop a multiparametric MRI (mpMRI) model for breast cancer diagnosis incorporating American College of Radiology (ACR) BI‐RADS recommended descriptors for breast MRI with DCE, T2‐weighted imaging, and DWI with apparent diffusion coefficient (ADC) mapping. Study Type Retrospective. Subjects In all, 188 patients (mean 51.6 years) with 210 breast tumors (136 malignant and 74 benign) who underwent mpMRI from December 2010 to September 2014. Field Strength/Sequence IR inversion recovert DCE‐MRI dynamic contrast‐enhanced magnetic resonance imaging VIBE Volume‐Interpolated‐Breathhold‐Examination FLASH turbo fast‐low‐angle‐shot TWIST Time‐resolved angiography with stochastic Trajectories. Assessment Two radiologists in consensus and another radiologist independently evaluated the mpMRI data. Characteristics for mass (n = 182) and nonmass (n = 28) lesions were recorded on DCE and T2‐weighted imaging according to BI‐RADS, as well as DWI descriptors. Two separate models were analyzed, using DCE‐MRI BI‐RADS descriptors, T2‐weighted imagines, and ADCmean as either a continuous or binary form using a previously published ADC cutoff value of ≤1.25 × 10−3 mm2/sec for differentiation between benign and malignant lesions. Histopathology was the standard of reference. Statistical Tests χ2 test, Fisher's exact test, Kruskal–Wallis test, Pearson correlation coefficient, multivariate logistic regression analysis, Hosmer–Lemeshow test of goodness‐of‐fit, receiver operating characteristics analysis. Results In Model 1, ADCmean (P = 0.0031), mass margins with DCE (P = 0.0016), and delayed enhancement with DCE (P = 0.0016) were significantly and independently associated with breast cancer diagnosis; Model 2 identified ADCmean (P = 0.0031), mass margins with DCE (P = 0.0012), initial enhancement (P = 0.0422), and delayed enhancement with DCE (P = 0.0065) to be significantly independently associated with breast cancer diagnosis. T2‐weighted imaging variables were not included in the final models. Data Conclusion mpMRI with DCE‐MRI and DWI with ADC mapping enables accurate breast cancer diagnosis. A model using quantitative and qualitative descriptors from DCE‐MRI and DWI identifies breast cancer with a high diagnostic accuracy. T2‐weighted imaging does not significantly contribute to breast cancer diagnosis. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:864–874.
Collapse
Affiliation(s)
- Michelle Zhang
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA
| | - Joao V Horvat
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA
| | - Blanca Bernard-Davila
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA
| | - Maria Adele Marino
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA.,Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| | - Doris Leithner
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA.,University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt, Germany
| | - R Elena Ochoa-Albiztegui
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA
| | - Thomas H Helbich
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Elizabeth A Morris
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA
| | - Sunitha Thakur
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA
| | - Katja Pinker
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Breast Imaging Service, NY, New York, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| |
Collapse
|
195
|
Deike-Hofmann K, Koenig F, Paech D, Dreher C, Delorme S, Schlemmer HP, Bickelhaupt S. Abbreviated MRI Protocols in Breast Cancer Diagnostics. J Magn Reson Imaging 2018; 49:647-658. [PMID: 30328180 DOI: 10.1002/jmri.26525] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
Oncologic imaging focused on the detection of breast cancer is of increasing importance, with over 1.7 million new cases detected each year worldwide. MRI of the breast has been described to be one of the most sensitive imaging modalities in breast cancer detection; however, clinical use is limited due to high costs. In the past, the objective and clinical routine of oncologic imaging was to provide one extended imaging protocol covering all potential needs and clinical implications regardless of the specific clinical indication or question. Future protocols might be more focused according to a "keep it short and simple" approach, with a reduction of patient magnet time and a limited number of images to review. Rather than replacing conventional full-diagnostic breast MRI protocols, these approaches aim at introducing a new thinking in oncologic imaging using a diversification of available imaging approaches targeted to the dedicated clinical needs of the individual patient. Here we review current approaches on using abbreviated protocols that aim to increase the clinical availability and use of breast MRI for improved early detection of breast cancer. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:647-658.
Collapse
Affiliation(s)
| | - Franziska Koenig
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | - Daniel Paech
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | - Constantin Dreher
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | - Stefan Delorme
- German Cancer Research Center (dkfz), Department of Radiology, Heidelberg, Germany
| | | | | |
Collapse
|
196
|
Radovic N, Ivanac G, Divjak E, Biondic I, Bulum A, Brkljacic B. Evaluation of Breast Cancer Morphology Using Diffusion-Weighted and Dynamic Contrast-Enhanced MRI: Intermethod and Interobserver Agreement. J Magn Reson Imaging 2018; 49:1381-1390. [PMID: 30325549 DOI: 10.1002/jmri.26332] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The capability of diffusion-weighted imaging (DWI) for morphological analysis of breast lesions is underexplored. PURPOSE To evaluate the utility of DWI for assessment of morphological features of breast cancer by comparing DWI and dynamic contrast-enhanced (DCE) MRI findings to determine intermethod and interobserver agreement. STUDY TYPE Retrospective. POPULATION Seventy-eight women with pathohistologically proven breast cancer. FIELD STRENGTH/SEQUENCE 1.5T. DWI and DCE images. ASSESSMENT Diffusion-weighted and DCE images were placed in two separate case sets. Three radiologists, blinded to all other information, independently evaluated each case set on two separate occasions. Lesions were interpreted according to the fifth edition of the ACR BI-RADS lexicon. STATISTICAL ANALYSIS Kappa (κ) statistics were calculated in order to assess intermethod and interobserver agreement. RESULTS For values that attained statistical significance (P < 0.05), intermethod agreement ranged from fair (κ = 0.22) for nonmass internal patterns to significant (κ = 0.8) for lesion type. On DWI, interobserver agreement varied from fair (κ = 0.34) for mass shape to significant (κ = 0.75) for lesion type. On DCE MRI, interobserver agreement varied from fair (κ = 0.27) for irregular vs. spiculated mass margin to perfect (κ = 1) for circumscribed vs. noncircumscribed mass margin. DATA CONCLUSION On the whole, there was moderate intermethod agreement. The values of interobserver agreement were mostly similar between DWI and DCE MRI. This suggests that DWI is applicable for morphological assessment of breast cancer, notwithstanding substantially inferior spatial resolution compared to DCE MRI. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:1381-1390.
Collapse
Affiliation(s)
- Niko Radovic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gordana Ivanac
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Eugen Divjak
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Iva Biondic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Antonio Bulum
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| |
Collapse
|
197
|
Pujara AC, Kim E, Axelrod D, Melsaether AN. PET/MRI in Breast Cancer. J Magn Reson Imaging 2018; 49:328-342. [DOI: 10.1002/jmri.26298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Akshat C. Pujara
- Department of Radiology, Division of Breast Imaging; University of Michigan Health System; Ann Arbor Michigan USA
| | - Eric Kim
- Department of Radiology; NYU School of Medicine; New York New York USA
| | - Deborah Axelrod
- Department of Surgery; Perlmutter Cancer Center, NYU School of Medicine; New York New York USA
| | - Amy N. Melsaether
- Department of Radiology; NYU School of Medicine; New York New York USA
| |
Collapse
|
198
|
Kuhl CK. Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol 2018; 91:20170441. [PMID: 28749202 PMCID: PMC6350487 DOI: 10.1259/bjr.20170441] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 11/22/2022] Open
Abstract
Early diagnosis improves survival of females with breast cancer. Mammographic screening improves early diagnosis of breast cancer. And yet, there appears to be room for improvement. Major shortcomings of mammographic screening are overdiagnosis of prognostically unimportant cancer, as well as underdiagnosis of cancers that are indeed relevant. Failure to detect biologically relevant breast cancer with mammographic screening is driven not only by host-related factors, i.e. breast tissue density, but also by tumour-related factors: Biologically relevant cancers may exhibit imaging features that render them indistinguishable from normal or benign breast tissue on mammography. These cancers will then progress to become the advanced-stage interval cancers observed in females undergoing mammographic screening. Since breast cancer continues to represent a major cause of cancer death in females, the search for improved breast cancer screening method continues. Abbreviated breast MRI has been proposed for this purpose because it will greatly reduce the cost associated with this method, due to a greatly reduced magnet time (down to 3 min), but especially also due to a greatly abridged image interpretation time, i.e. radiologist reading time. This commentary reviews the current situation and presents the EA1141 trial designed to investigate the utility of abbreviated breast MRI for screening average-risk females with dense breast tissue.
Collapse
Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen, RWTH, Aachen, Germany
| |
Collapse
|
199
|
Li X, Rispoli JV. Toward 7T breast MRI clinical study: safety assessment using simulation of heterogeneous breast models in RF exposure. Magn Reson Med 2018; 81:1307-1321. [PMID: 30216530 DOI: 10.1002/mrm.27395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/19/2018] [Accepted: 05/17/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To facilitate assessment of RF power deposition and temperature rise within the breast, we present a method to seamlessly join heterogeneous breast models with standard whole-body models and demonstrate simulations at 7 T. METHODS Finite-difference time-domain electromagnetic and bioheat simulations are performed to analyze the specific absorption rate (SAR) and temperature rise distributions in 36 Breast Imaging Reporting and Data System (BI-RADS) categorized breast models fused to 2 female whole-body models while transmitting from a 7T breast volume coil. The breast models are uncompressed in the prone position and feature heterogeneous tissue contents; fusion with human models uses affine transformation and the level-set method. RESULTS The fusion method produces a continuous transient from the chest region to the posterior portion of breast models while preserving the original volume and shape of breast models. Simulation results of both Ella and Hanako models indicate that the maximum local SAR, partial body SAR, and local tissue temperature rise are positively correlated with both breast density and the highest BI-RADS density classification. Additionally, maximum local tissue temperature rise is positively correlated with maximum 10-g SAR values. CONCLUSION Fibroglandular tissue content plays an important role in the distribution of SAR and temperature rise within breast tissue. The combined body-breast models preserve the integrity of breast models while concurrently exhibiting the loading of whole-body human models. The procedures presented in this simulation study facilitate safety assessments for breast MRI across the population at both clinical and ultrahigh field strengths.
Collapse
Affiliation(s)
- Xin Li
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Joseph V Rispoli
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.,School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana.,Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana
| |
Collapse
|
200
|
Leithner D, Moy L, Morris EA, Marino MA, Helbich TH, Pinker K. Abbreviated MRI of the Breast: Does It Provide Value? J Magn Reson Imaging 2018; 49:e85-e100. [PMID: 30194749 PMCID: PMC6408315 DOI: 10.1002/jmri.26291] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
MRI of the breast is the most sensitive test for breast cancer detection and outperforms conventional imaging with mammography, digital breast tomosynthesis, or ultrasound. However, the long scan time and relatively high costs limit its widespread use. Hence, it is currently only routinely implemented in the screening of women at an increased risk of breast cancer. To overcome these limitations, abbreviated dynamic contrast‐enhanced (DCE)‐MRI protocols have been introduced that substantially shorten image acquisition and interpretation time while maintaining a high diagnostic accuracy. Efforts to develop abbreviated MRI protocols reflect the increasing scrutiny of the disproportionate contribution of radiology to the rising overall healthcare expenditures. Healthcare policy makers are now focusing on curbing the use of advanced imaging examinations such as MRI while continuing to promote the quality and appropriateness of imaging. An important cornerstone of value‐based healthcare defines value as the patient's outcome over costs. Therefore, the concept of a fast, abbreviated MRI exam is very appealing, given its high diagnostic accuracy coupled with the possibility of a marked reduction in the cost of an MRI examination. Given recent concerns about gadolinium‐based contrast agents, unenhanced MRI techniques such as diffusion‐weighted imaging (DWI) are also being investigated for breast cancer diagnosis. Although further larger prospective studies, standardized imaging protocol, and reproducibility studies are necessary, initial results with abbreviated MRI protocols suggest that it seems feasible to offer screening breast DCE‐MRI to a broader population. This article aims to give an overview of abbreviated and fast breast MRI protocols, their utility for breast cancer detection, and their emerging role in the new value‐based healthcare paradigm that has replaced the fee‐for‐service model. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:e85–e100.
Collapse
Affiliation(s)
- Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, New York, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria A Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
| |
Collapse
|