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Garcia EM, Storm ES, Atkinson L, Kenny E, Mitchell LS. Current Breast Imaging Modalities, Advances, and Impact on Breast Care. Obstet Gynecol Clin North Am 2013; 40:429-57. [DOI: 10.1016/j.ogc.2013.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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202
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Chae EY, Kim HH, Cha JH, Shin HJ, Kim H. Evaluation of screening whole-breast sonography as a supplemental tool in conjunction with mammography in women with dense breasts. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1573-1578. [PMID: 23980217 DOI: 10.7863/ultra.32.9.1573] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the use and performance of supplemental screening whole-breast sonography in conjunction with mammography in asymptomatic women with dense breast tissue. METHODS A total of 28,796 asymptomatic women underwent screening mammography. Among 20,864 women with dense breasts (72%), 8359 underwent additional sonography as part of their screening examinations. We classified women with mammographically dense breasts into mammography-only and mammography-plus-sonography groups. The reference standard was a combination of pathologic results and clinical follow-up at 2 years. We compared the recall rate, cancer detection yield, sensitivity, specificity, and positive predictive value in each group. RESULTS Among the 20,864 women with dense breasts, 35 cancers were diagnosed, with a mean size of 13 mm. The cancer detection yield was 0.480 per 1000 women in the mammography-only group and increased to 2.871 in the mammography-plus-sonography group. Of 24 cancers detected in the mammography-plus-sonography group, the mean size was 11 mm, and the axillary lymph nodes were negative in 19 of 20. The sensitivity was significantly higher in the mammography-plus-sonography group than the mammography-only group (100% versus 54.55%; P = .002). The positive predictive values of sonographically prompted biopsy were 11.1% for the mammography-plus-sonography group and 50% for the mammography-only group. CONCLUSIONS Supplemental screening whole-breast sonography increases the cancer detection yield by 2.391 cancers per 1000 women with dense breast tissue over that of mammography alone. It is beneficial for increased detection of breast cancers that are predominantly small and node negative; however, it also raises the number of false-positive results.
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Affiliation(s)
- Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 138-736, Korea
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Drukteinis JS, Mooney BP, Flowers CI, Gatenby RA. Beyond mammography: new frontiers in breast cancer screening. Am J Med 2013; 126:472-9. [PMID: 23561631 PMCID: PMC4010151 DOI: 10.1016/j.amjmed.2012.11.025] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 11/27/2012] [Accepted: 11/30/2012] [Indexed: 12/16/2022]
Abstract
Breast cancer screening remains a subject of intense and, at times, passionate debate. Mammography has long been the mainstay of breast cancer detection and is the only screening test proven to reduce mortality. Although it remains the gold standard of breast cancer screening, there is increasing awareness of subpopulations of women for whom mammography has reduced sensitivity. Mammography also has undergone increased scrutiny for false positives and excessive biopsies, which increase radiation dose, cost, and patient anxiety. In response to these challenges, new technologies for breast cancer screening have been developed, including low-dose mammography, contrast-enhanced mammography, tomosynthesis, automated whole breast ultrasound, molecular imaging, and magnetic resonance imaging. Here we examine some of the current controversies and promising new technologies that may improve detection of breast cancer both in the general population and in high-risk groups, such as women with dense breasts. We propose that optimal breast cancer screening will ultimately require a personalized approach based on metrics of cancer risk with selective application of specific screening technologies best suited to the individual's age, risk, and breast density.
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Statistical evaluation of a fully automated mammographic breast density algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:651091. [PMID: 23737861 PMCID: PMC3662119 DOI: 10.1155/2013/651091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
Abstract
Visual assessments of mammographic breast density by radiologists are used in clinical practice; however, these assessments have shown weaker associations with breast cancer risk than area-based, quantitative methods. The purpose of this study is to present a statistical evaluation of a fully automated, area-based mammographic density measurement algorithm. Five radiologists
estimated density in 5% increments for 138 “For Presentation” single MLO views; the median of the radiologists' estimates was used as the reference standard. Agreement amongst radiologists was excellent, ICC = 0.884, 95% CI (0.854, 0.910). Similarly, the agreement between the algorithm and the reference standard was excellent, ICC = 0.862, falling within the 95% CI of the radiologists' estimates. The Bland-Altman plot showed that the reference standard was slightly positively biased (+1.86%) compared to the algorithm-generated densities. A scatter plot showed that the algorithm moderately overestimated low densities and underestimated high densities. A box plot showed that 95% of the algorithm-generated assessments fell within one BI-RADS category of the reference standard. This study demonstrates the effective use of several statistical techniques that collectively produce a comprehensive evaluation of the algorithm and its potential to provide mammographic density measures that can be used to inform clinical practice.
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Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol 2013; 23:2087-94. [DOI: 10.1007/s00330-013-2831-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/07/2013] [Accepted: 02/21/2013] [Indexed: 10/26/2022]
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Yaghjyan L, Colditz GA, Rosner B, Tamimi RM. Mammographic breast density and subsequent risk of breast cancer in postmenopausal women according to the time since the mammogram. Cancer Epidemiol Biomarkers Prev 2013; 22:1110-7. [PMID: 23603205 DOI: 10.1158/1055-9965.epi-13-0169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have shown that the association between mammographic breast density and breast cancer persists for up to 10 years after the mammogram. We investigated associations of percent density, absolute dense, and nondense areas with breast cancer risk according to the time since the mammogram. METHODS This study included 1,028 incident breast cancer cases diagnosed within the Nurses' Health Study and 1,780 matched controls. Breast density was measured from digitized film images with computerized techniques. Information on breast cancer risk factors was obtained prospectively from the biennial questionnaires before the date of cancer diagnosis for cases and their matched controls. The data were analyzed with logistic regression. RESULTS Breast cancer risk increased with increasing percent density and increasing absolute dense area and decreased with increasing nondense area. In multivariate analysis, the magnitude of the association between percent density and breast cancer was similar when the time since the mammogram was <2, 2 to <5, and 5 to <10 years [density ≥50% vs.<10%: ORs, 3.12; 95% confidence interval (CI): 1.55-6.25, 5.35 (95% CI: 2.93-9.76), and 3.91 (95%CI: 2.22-6.88), respectively]. Similarly, the magnitude of association between quartiles of dense and nondense areas and breast cancer risk were similar across the time strata. We found no interactions between the time since the mammogram and breast density measures (Pinteraction > 0.05). CONCLUSIONS Patterns of the associations between percent density, absolute dense, and nondense area with breast cancer risk persist for up to 10 years after the mammogram. IMPACT A one-time density measure can be used for long-term breast cancer risk prediction.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Surgery; Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
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207
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Ultrasonographic assessment of breast density. Breast Cancer Res Treat 2013; 138:851-9. [DOI: 10.1007/s10549-013-2506-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/25/2013] [Indexed: 10/27/2022]
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Voevodina O, Billich C, Arand B, Nagel G. Association of Mediterranean diet, dietary supplements and alcohol consumption with breast density among women in South Germany: a cross-sectional study. BMC Public Health 2013; 13:203. [PMID: 23497280 PMCID: PMC3599490 DOI: 10.1186/1471-2458-13-203] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 02/27/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Effects of dietary factors, such as adherence to Mediterranean diet, multivitamin-multimineral supplements use and alcohol consumption on mammographic breast density, an important biomarker of breast cancer risk, are not sufficiently consistent to elaborate preventive recommendations. This study aims to investigate the association between current diet and mammographic density. METHODS We performed a cross-sectional study in 424 pre- and post-menopausal women aged 21 to 84 years. Current Mediterranean dietary pattern, multivitamin-multimineral supplements use, alcohol consumption and potential confounders were assessed with a self-administered questionnaire in the University Hospital Ulm (2007-2008). Radiologists evaluated mammographic density according to the American College of Radiology (ACR) classification, which was summarized in low = ACR1/2 and high = ACR3/4 mammographic density. Logistic regression models were used to assess the association between current diet and mammographic density. RESULTS Adherance to Mediterranean dietary pattern was inversely associated with mammographic density in the models adjusted for age and BMI (per 1 unit increase of score OR 0.95; 95%CI 0.90-0.997). Current use of multivitamin-multimineral supplements was also inversely associated with mammographic density (OR 0.53; 95%CI 0.34-0.83). Further adjustment revealed similar point estimates but the associations were no longer statistically significant. Compared to non-drinkers, excessive alcohol consumption (<10 g/d) was positively associated with mammographic density (OR 1.47; 95%CI 0.82-2.63). CONCLUSIONS Our results show that dietary factors are associated with mammographic density. Adherence to Mediterranean diet and current use of multivitamin-multimineral supplements could be inversely associated with mammographic density and may suggest a protective effect against breast cancer, whereas high alcohol consumption was associated with increased mammographic density.
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Affiliation(s)
- Olga Voevodina
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm 89081, Germany
| | - Christian Billich
- Departement of Diagnostic and Interventional Radiology, Ulm University, Prittwitzstrasse 43, Ulm, 89075, Germany
| | - Birke Arand
- Clinic Ludwigsburg, Posilipostr. 4, Ludwigsburg, 71640, Germany
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, Ulm 89081, Germany
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O'Sullivan TD, Leproux A, Chen JH, Bahri S, Matlock A, Roblyer D, McLaren CE, Chen WP, Cerussi AE, Su MY, Tromberg BJ. Optical imaging correlates with magnetic resonance imaging breast density and reveals composition changes during neoadjuvant chemotherapy. Breast Cancer Res 2013; 15:R14. [PMID: 23433249 PMCID: PMC3672664 DOI: 10.1186/bcr3389] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/22/2013] [Indexed: 12/17/2022] Open
Abstract
Introduction In addition to being a risk factor for breast cancer, breast density has been
hypothesized to be a surrogate biomarker for predicting response to
endocrine-based chemotherapies. The purpose of this study was to evaluate whether
a noninvasive bedside scanner based on diffuse optical spectroscopic imaging
(DOSI) provides quantitative metrics to measure and track changes in breast tissue
composition and density. To access a broad range of densities in a limited patient
population, we performed optical measurements on the contralateral normal breast
of patients before and during neoadjuvant chemotherapy (NAC). In this work, DOSI
parameters, including tissue hemoglobin, water, and lipid concentrations, were
obtained and correlated with magnetic resonance imaging (MRI)-measured
fibroglandular tissue density. We evaluated how DOSI could be used to assess
breast density while gaining new insight into the impact of chemotherapy on breast
tissue. Methods This was a retrospective study of 28 volunteers undergoing NAC treatment for
breast cancer. Both 3.0-T MRI and broadband DOSI (650 to 1,000 nm) were obtained
from the contralateral normal breast before and during NAC. Longitudinal DOSI
measurements were used to calculate breast tissue concentrations of oxygenated and
deoxygenated hemoglobin, water, and lipid. These values were compared with
MRI-measured fibroglandular density before and during therapy. Results Water (r = 0.843; P < 0.001), deoxyhemoglobin (r =
0.785; P = 0.003), and lipid (r = -0.707; P = 0.010)
concentration measured with DOSI correlated strongly with MRI-measured density
before therapy. Mean DOSI parameters differed significantly between pre- and
postmenopausal subjects at baseline (water, P < 0.001;
deoxyhemoglobin, P = 0.024; lipid, P = 0.006). During NAC
treatment measured at about 90 days, significant reductions were observed in
oxyhemoglobin for pre- (-20.0%; 95% confidence interval (CI), -32.7 to -7.4) and
postmenopausal subjects (-20.1%; 95% CI, -31.4 to -8.8), and water concentration
for premenopausal subjects (-11.9%; 95% CI, -17.1 to -6.7) compared with baseline.
Lipid increased slightly in premenopausal subjects (3.8%; 95% CI, 1.1 to 6.5), and
water increased slightly in postmenopausal subjects (4.4%; 95% CI, 0.1 to 8.6).
Percentage change in water at the end of therapy compared with baseline correlated
strongly with percentage change in MRI-measured density (r = 0.864; P
= 0.012). Conclusions DOSI functional measurements correlate with MRI fibroglandular density, both
before therapy and during NAC. Although from a limited patient dataset, these
results suggest that DOSI may provide new functional indices of density based on
hemoglobin and water that could be used at the bedside to assess response to
therapy and evaluate disease risk.
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210
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Automated volumetric breast density estimation: a comparison with visual assessment. Clin Radiol 2013; 68:690-5. [PMID: 23434202 DOI: 10.1016/j.crad.2013.01.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/24/2012] [Accepted: 01/14/2013] [Indexed: 11/22/2022]
Abstract
AIM To compare automated volumetric breast density (VBD) measurement with visual assessment according to Breast Imaging Reporting and Data System (BI-RADS), and to determine the factors influencing the agreement between them. MATERIALS AND METHODS One hundred and ninety-three consecutive screening mammograms reported as negative were included in the study. Three radiologists assigned qualitative BI-RADS density categories to the mammograms. An automated volumetric breast-density method was used to measure VBD (% breast density) and density grade (VDG). Each case was classified into an agreement or disagreement group according to the comparison between visual assessment and VDG. The correlation between visual assessment and VDG was obtained. Various physical factors were compared between the two groups. RESULTS Agreement between visual assessment by the radiologists and VDG was good (ICC value = 0.757). VBD showed a highly significant positive correlation with visual assessment (Spearman's ρ = 0.754, p < 0.001). VBD and the x-ray tube target was significantly different between the agreement group and the disagreement groups (p = 0.02 and 0.04, respectively). CONCLUSION Automated VBD is a reliable objective method to measure breast density. The agreement between VDG and visual assessment by radiologist might be influenced by physical factors.
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211
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Diet across the Lifespan and the Association with Breast Density in Adulthood. Int J Breast Cancer 2013; 2013:808317. [PMID: 23431461 PMCID: PMC3574651 DOI: 10.1155/2013/808317] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/30/2012] [Indexed: 02/01/2023] Open
Abstract
Studies have shown inconsistent results regarding the association between dietary factors across the lifespan and breast density and breast cancer in women. Breast density is a strong risk factor for breast cancer, and the mechanism through which it influences cancer risk remains unclear. Breast density has been shown to be modifiable, potentially through dietary modifications. The goal of this paper is to summarize the current studies on diet and diet-related factors across all ages, determine which dietary factors show the strongest association with breast density, the most critical age of exposure, and identify future directions. We identified 28 studies, many of which are cross-sectional, and found that the strongest associations are among vitamin D, calcium, dietary fat, and alcohol in premenopausal women. Longitudinal studies with repeated dietary measures as well as the examination of overall diet over time are needed to confirm these findings.
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212
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Comparative estimation of percentage breast tissue density for digital mammography, digital breast tomosynthesis, and magnetic resonance imaging. Breast Cancer Res Treat 2013; 138:311-7. [PMID: 23338763 DOI: 10.1007/s10549-013-2419-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
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Harvey JA, Gard CC, Miglioretti DL, Yankaskas BC, Kerlikowske K, Buist DSM, Geller BA, Onega TL. Reported mammographic density: film-screen versus digital acquisition. Radiology 2012; 266:752-8. [PMID: 23249570 DOI: 10.1148/radiol.12120221] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To test the hypothesis that American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories for breast density reported by radiologists are lower when digital mammography is used than those reported when film-screen (FS) mammography is used. MATERIALS AND METHODS This study was institutional review board approved and HIPAA compliant. Demographic data, risk factors, and BI-RADS breast density categories were collected from five mammography registries that were part of the Breast Cancer Surveillance Consortium. Active, passive, or waiver of consent was obtained for all participants. Women aged 40 years and older who underwent at least two screening mammographic examinations less than 36 months apart between January 1, 2000, and December 31, 2009, were included. Women with prior breast cancer, augmentation, or use of agents known to affect density were excluded. The main sample included 89 639 women with both FS and digital mammograms. The comparison group included 259 046 women with two FS mammograms and 87 066 women with two digital mammograms. BI-RADS density was cross-tabulated according to the order in which the two types of mammogram were acquired and by the first versus second interpretation. RESULTS Regardless of acquisition method, the percentage of women with a change in density from one reading to the next was similar. Breast density was lower in 19.8% of the women who underwent FS before digital mammography and 17.1% of those who underwent digital before FS mammography. Similarly, lower density classifications were reported on the basis of the second mammographic examination regardless of acquisition method (15.8%-19.8%). The percentage of agreement between density readings was similar regardless of mammographic types paired (67.3%-71.0%). CONCLUSION The study results showed no difference in reported BI-RADS breast density categories according to acquisition method. Reported BI-RADS density categories may be useful in the development of breast cancer risk models in which FS, digital, or both acquisition methods are used.
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Affiliation(s)
- Jennifer A Harvey
- Department of Radiology, University of Virginia, Box 800170, Charlottesville, VA 22908, USA.
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Galukande M, Kiguli-Malwadde E. Mammographic breast density patterns among a group of women in sub Saharan Africa. Afr Health Sci 2012; 12:422-5. [PMID: 23515353 DOI: 10.4314/ahs.v12i4.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mammographic breast density is a measure of parenchymal breast patterns on film and in part a marker of cumulative exposure to oestrogen. The risk of breast cancer for women with increased density is up to six fold more than in women with less dense tissues. The pattern of mammographic breast density among Ugandan women is not known. OBJECTIVE To establish these as a contribution to baseline data. METHODS A cross sectional descriptive study that enrolled women presenting for mammography at the national referral hospital radiology department. Breast densities were scored using the BI-RADS categories. IRB approval was obtained. RESULTS Of the 190 women enrolled, 178 were scored, of those scored 10 (5.3%) had extremely dense breasts (grade IV) and 39 (20.5%) had heteregenous ones (grade III). The rest 129 (67.9%) had scattered fibroglandular or fat densities (Grades I & II). Most of the women were young 45.8 ± 12.5 years The majority had normal or benign mammographic findings and all were non pregnant. CONCLUSION Mammographic densities in this Ugandan population appear to be of low grade. The pattern established here is markedly different from findings in other studies that indicated much higher proportions for high dense tissues in other races. Mammographic interpretation of films could therefore be easier.
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Affiliation(s)
- M Galukande
- Surgery department, College of Health Sciences, Makerere University, Uganda.
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215
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Alonzo-Proulx O, Jong RA, Yaffe MJ. Volumetric breast density characteristics as determined from digital mammograms. Phys Med Biol 2012; 57:7443-57. [DOI: 10.1088/0031-9155/57/22/7443] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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216
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Baldisserotto FDG, Elias S, Silva IDCG, Nazario ACP. The relationship between estrogen receptor gene polymorphism and mammographic density in postmenopausal women. Climacteric 2012; 16:369-80. [PMID: 23078272 DOI: 10.3109/13697137.2012.721823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the relationship between the presence of PVUII and XBAI polymorphisms in the estrogen receptor α gene and mammographic density in postmenopausal women. METHODS For the present analysis, 189 postmenopausal women who had never used hormonal therapy and who did not have clinical or mammographic features were selected. Based on the ACR-BIRADS(®) 2003 classification, the mammographic density was determined by three independent readers (two subjective ratings and one computerized). Blood samples were available to extract DNA according to KIT GFX(®) protocol. PCR-RFLP was then used to identify the polymorphisms. RESULTS There was a high degree of agreement among the three readers to determine the mammographic density (κ > 0.75). Sixty women (32%) had dense breasts and 129 (68%) had non-dense breasts. The PVUII polymorphism was found in 132 (69.8%) of 189 women, while the XBAI polymorphism was found in 135 (71.4%) women. Parity (p = 0.02) and body mass index (p < 0.0001) were associated with mammographic density. It was observed that, for the XBAI polymorphism, women with two mutated alleles were approximately 2.5 times more likely to be classified in the dense breasts group (p = 0.003) and the presence of both wild alleles was associated with fibroglandular tissue replacement by fat (p = 0.02). CONCLUSIONS There was no significant association of the PVUII polymorphism in the estrogen receptor α gene with mammographic density (p = 0.34). However, the XBAI polymorphism was observed at a higher mutated homozygous frequency in women with dense breasts and there was an increased frequency of wild-type homozygous and heterozygous women with fat-replaced breasts (p = 0.01).
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Affiliation(s)
- F D G Baldisserotto
- Department of Gynecology of the Federal University of Sao Paulo, Sao Paulo, Brazil
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217
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Leong LCH, Gogna A, Pant R, Ng FC, Sim LSJ. Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n10p432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Dense breasts are common in Asian women and they limit the sensitivity of mammography. This study evaluates the performance of supplementary breast ultrasound screening in Asian women with dense mammograms. Materials and Methods: The study was approved by the hospital’s Institutional Review Board. A prospective clinical trial was performed between September 2002 and November 2004. Asymptomatic Asian women with negative and dense mammograms were offered supplementary ultrasound screening for breast cancer. Ultrasound assessment was categorised as U1 to U4. U1 and U2 cases were recommended routine interval screening mammography. U3 cases were recommended follow-up ultrasound in 6 months and routine interval screening mammography and U4 cases were recommended biopsy. Results: One hundred and forty-one women with mean age of 45.1 years were enrolled into the study. Mean scan time was 13.0 minutes (± 5.6 minutes) for bilateral vs 11.0 minutes (± 1.4 minutes) for unilateral scans. There were 10 patients and 14 patients in the in the U3 and U4 categories, respectively. Two U4 category patients were diagnosed with malignancy—a-6 mm ductal carcinoma-in-situ and a 13-mm invasive ductal carcinoma. The breast cancer detection rate was 1.4%. Sensitivity and specificity were 100% (2/2) and 88.5% (92/104) respectively. The positive predictive value was 14.3% (2/14) and the negative predictive value was 100% (92/92). Conclusion: This pilot study reveals the usefulness of supplementary ultrasound screening in detecting early stage mammographically and clinically occult breast cancers in Asian women with dense breasts. A larger long-term study is, however, needed to assess its feasibility and impact on breast cancer prognosis.
Key words: Asian, Breast, Dense, Screening, Ultrasound
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Affiliation(s)
| | | | - Rita Pant
- King Faisal Specialist Hospital and Research Centre. Riyadh, Saudi Arabia
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Cecchini RS, Costantino JP, Cauley JA, Cronin WM, Wickerham DL, Bandos H, Weissfeld JL, Wolmark N. Baseline mammographic breast density and the risk of invasive breast cancer in postmenopausal women participating in the NSABP study of tamoxifen and raloxifene (STAR). Cancer Prev Res (Phila) 2012; 5:1321-9. [PMID: 23060039 DOI: 10.1158/1940-6207.capr-12-0273] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mammographic breast density is an established risk factor for breast cancer. However, results are inconclusive regarding its use in risk prediction models. The current study evaluated 13,409 postmenopausal participants in the NSABP Study of Tamoxifen and Raloxifene. A measure of breast density as reported on the entry mammogram report was extracted and categorized according to The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classifications. An increased risk of invasive breast cancer was associated with higher mammographic breast density (P < 0.001). The association remained significant after adjusting for age, treatment, and smoking history [HR 1.35, 95% confidence interval (CI): 1.16-1.58], as well as when added to a model including the Gail score (HR 1.33, 95% CI: 1.14-1.55). At five years after random assignment, time-dependent area under the curve (AUC) improved from 0.63 for a model with Gail score alone to 0.64 when considering breast density and Gail score. Breast density was also significant when added to an abbreviated model tailored for estrogen receptor-positive breast cancers (P = 0.02). In this study, high BI-RADS breast density was significantly associated with increased breast cancer risk when considered in conjunction with Gail score but provided only slight improvement to the Gail score for predicting the incidence of invasive breast cancer. The BI-RADS breast composition classification system is a quick and readily available method for assessing breast density for risk prediction evaluations; however, its addition to the Gail model does not seem to provide substantial predictability improvements in this population of postmenopausal healthy women at increased risk for breast cancer.
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Affiliation(s)
- Reena S Cecchini
- NSABP Biostatistical Center, One Sterling Plaza, Pittsburgh, PA 15213, USA.
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Chen JH, Chan S, Liu YJ, Yeh DC, Chang CK, Chen LK, Pan WF, Kuo CC, Lin M, Chang DHE, Fwu PT, Su MY. Consistency of breast density measured from the same women in four different MR scanners. Med Phys 2012; 39:4886-95. [PMID: 22894415 DOI: 10.1118/1.4736824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To compare the breast volume (BV), fibroglandular tissue volume (FV), and percent density (PD) measured from breast MRI of the same women using four different MR scanners. METHODS The study was performed in 34 healthy Asian volunteers using two 1.5T (GE and Siemens) and two 3T (GE and Philips) MR scanners. The BV, FV, and PD were measured on nonfat-suppressed T1-weighted images using a comprehensive computer algorithm-based segmentation method. The scanner-to-scanner measurement difference, and the coefficient of variation (CV) among the four scanners were calculated. The measurement variation between two density morphological patterns presenting as the central type and the intermingled type was separately analyzed and compared. RESULTS All four scanners provided satisfactory image quality allowing for successful completion of the segmentation processes. The measured parameters between each pair of MR scanners were highly correlated, with R(2) ≥ 0.95 for BV, R(2) ≥ 0.99 for FV, and R(2) ≥ 0.97 for PD in all comparisons. The mean percent differences between each pair of scanners were 5.9%-7.8% for BV, 5.3%-6.5% for FV, 4.3%-7.3% for PD; with the overall CV of 5.8% for BV, 4.8% for FV, and 4.9% for PD. The variation of FV was smaller in the central type than in the intermingled type (p = 0.04). CONCLUSIONS The results showed that the variation of FV and PD measured from four different MR scanners is around 5%, suggesting the parameters measured using different scanners can be used for a combined analysis in a multicenter study.
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Affiliation(s)
- Jeon-Hor Chen
- Tu and Yuen Center for Functional Onco-Imaging of Department of Radiological Science, University of California Irvine, California 92697-5020, USA.
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Weigert J, Steenbergen S. The Connecticut Experiment: The Role of Ultrasound in the Screening of Women With Dense Breasts. Breast J 2012; 18:517-22. [DOI: 10.1111/tbj.12003] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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221
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Yaghjyan L, Colditz GA, Wolin K. Physical activity and mammographic breast density: a systematic review. Breast Cancer Res Treat 2012; 135:367-80. [PMID: 22814722 PMCID: PMC3641148 DOI: 10.1007/s10549-012-2152-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
Studies show a protective relationship between physical activity and breast cancer risk across the life course from menarche to postmenopausal years. Mammographic breast density is a known and strong breast cancer risk factor. Whether the association of physical activity with breast cancer risk is mediated through mammographic breast density is poorly understood. This systematic review summarizes published studies that investigated the association between physical activity and mammographic breast density and discusses the methodological issues that need to be addressed. We included in this review studies that were published before October 31, 2011 that were accessible in full-text format and were published in English. We identified 20 studies through the PubMed Central, BioMed Central, Embase, and Scopus and using the search terms "physical activity and breast density" and "exercise and breast density" as well as through manual searches of the bibliographies of the articles identified in electronic searches. We found no evidence of association between physical activity and breast density across the studies by grouping them first by the timing of physical activity assessment (in adolescence, current/recent, past, and lifetime) and then by women's menopausal status (premenopausal and postmenopausal). Given the strength of the relationship between physical activity and breast cancer and the null findings of this review, it is unlikely that the effect of physical activity is mediated through an effect on breast density.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis 63110, MO, USA
| | - Graham A. Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis 63110, MO, USA. Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA. Alvin J Siteman Cancer Center, St. Louis, MO, USA
| | - Kathleen Wolin
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis 63110, MO, USA. Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA. Alvin J Siteman Cancer Center, St. Louis, MO, USA
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222
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Ding H, Molloi S. Quantification of breast density with spectral mammography based on a scanned multi-slit photon-counting detector: a feasibility study. Phys Med Biol 2012; 57:4719-38. [PMID: 22771941 PMCID: PMC3478949 DOI: 10.1088/0031-9155/57/15/4719] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A simple and accurate measurement of breast density is crucial for the understanding of its impact in breast cancer risk models. The feasibility to quantify volumetric breast density with a photon-counting spectral mammography system has been investigated using both computer simulations and physical phantom studies. A computer simulation model involved polyenergetic spectra from a tungsten anode x-ray tube and a Si-based photon-counting detector has been evaluated for breast density quantification. The figure-of-merit (FOM), which was defined as the signal-to-noise ratio of the dual energy image with respect to the square root of mean glandular dose, was chosen to optimize the imaging protocols, in terms of tube voltage and splitting energy. A scanning multi-slit photon-counting spectral mammography system has been employed in the experimental study to quantitatively measure breast density using dual energy decomposition with glandular and adipose equivalent phantoms of uniform thickness. Four different phantom studies were designed to evaluate the accuracy of the technique, each of which addressed one specific variable in the phantom configurations, including thickness, density, area and shape. In addition to the standard calibration fitting function used for dual energy decomposition, a modified fitting function has been proposed, which brought the tube voltages used in the imaging tasks as the third variable in dual energy decomposition. For an average sized 4.5 cm thick breast, the FOM was maximized with a tube voltage of 46 kVp and a splitting energy of 24 keV. To be consistent with the tube voltage used in current clinical screening exam (∼32 kVp), the optimal splitting energy was proposed to be 22 keV, which offered a FOM greater than 90% of the optimal value. In the experimental investigation, the root-mean-square (RMS) error in breast density quantification for all four phantom studies was estimated to be approximately 1.54% using standard calibration function. The results from the modified fitting function, which integrated the tube voltage as a variable in the calibration, indicated a RMS error of approximately 1.35% for all four studies. The results of the current study suggest that photon-counting spectral mammography systems may potentially be implemented for an accurate quantification of volumetric breast density, with an RMS error of less than 2%, using the proposed dual energy imaging technique.
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Affiliation(s)
- Huanjun Ding
- Department of Radiological Sciences University of California Irvine, CA 92697, USA
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223
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Spayne MC, Gard CC, Skelly J, Miglioretti DL, Vacek PM, Geller BM. Reproducibility of BI-RADS breast density measures among community radiologists: a prospective cohort study. Breast J 2012; 18:326-33. [PMID: 22607064 PMCID: PMC3660069 DOI: 10.1111/j.1524-4741.2012.01250.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Using data from the Vermont Breast Cancer Surveillance System (VBCSS), we studied the reproducibility of Breast Imaging Reporting and Data System (BI-RADS) breast density among community radiologists interpreting mammograms in a cohort of 11,755 postmenopausal women. Radiologists interpreting two or more film-screen screening or bilateral diagnostic mammograms for the same woman within a 3- to 24-month period during 1996-2006 were eligible. We observed moderate-to-substantial overall intra-rater agreement for use of BI-RADS breast density in clinical practice, with an overall intra-radiologist percent agreement of 77.2% (95% confidence interval (CI), 74.5-79.5%), an overall simple kappa of 0.58 (95% CI, 0.55-0.61), and an overall weighted kappa of 0.70 (95% CI, 0.68-0.73). Agreement exhibited by individual radiologists varied widely, with intra-radiologist percent agreement ranging from 62.1% to 87.4% and simple kappa ranging from 0.19 to 0.69 across individual radiologists. Our findings underscore the need for additional evaluation of the BI-RADS breast density categorization system in clinical practice.
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Affiliation(s)
| | - Charlotte C. Gard
- Biostatistics Unit, Group Health Research Institute, Group Health Cooperative, Seattle, WA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Joan Skelly
- Medical Biostatistics, University of Vermont, Burlington, VT
| | - Diana L. Miglioretti
- Biostatistics Unit, Group Health Research Institute, Group Health Cooperative, Seattle, WA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Pamela M. Vacek
- Medical Biostatistics, University of Vermont, Burlington, VT
| | - Berta M. Geller
- Departments of Family Medicine and Radiology, University of Vermont, Burlington, VT
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224
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Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology 2012; 265:59-69. [PMID: 22723501 DOI: 10.1148/radiol.12120621] [Citation(s) in RCA: 315] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine performance and utilization of screening breast ultrasonography (US) in women with dense breast tissue who underwent additional screening breast US in the 1st year since implementation of Connecticut Public Act 09-41 requiring radiologists to inform patients with heterogeneous or extremely dense breasts at mammography that they may benefit from such examination. MATERIALS AND METHODS Informed consent was waived for this institutional review board-approved, HIPAA-compliant retrospective review of 935 women with dense breasts at mammography who subsequently underwent handheld screening and whole-breast US from October 1, 2009, through September 30, 2010. RESULTS Of 935 women, 614 (65.7%) were at low risk, 149 (15.9%) were at intermediate risk, and 87 (9.3%) were at high risk for breast cancer. Of the screening breast US examinations, in 701 (75.0%), results were classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 or 2; in 187 (20.0%), results were classified as BI-RADS category 3; and in 47 (5.0%), results were classified as BI-RADS category 4. Of 63 aspirations or biopsies recommended and performed in 53 patients, in nine, lesions were BI-RADS category 3, and in 54, lesions were BI-RADS category 4. Among 63 biopsies and aspirations, three lesions were malignant (all BI-RADS category 4, diagnosed with biopsy). All three cancers were smaller than 1 cm, were found in postmenopausal patients, and were solid masses. One cancer was found in each risk group. In 44 of 935 (4.7%) patients, examination results were false-positive. Overall positive predictive value (PPV) for biopsy or aspirations performed in patients with BI-RADS category 4 masses was 6.5% (three of 46; 95% confidence interval [CI]: 1.7%, 19%). Overall cancer detection rate was 3.2 cancers per 1000 women screened (three of 935; 95% CI: 0.8 cancers per 1000 women screened, 10 cancers per 1000 women screened). CONCLUSION Technologist-performed handheld screening breast US offered to women in the general population with dense breasts can aid detection of small mammographically occult breast cancers (cancer detection rate, 0.8-10 cancers per 1000 women screened), although the overall PPV is low.
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Affiliation(s)
- Regina J Hooley
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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225
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Alvares BR, Freitas CHDA, Jales RM, Almeida OJD, Marussi EF. Mammographic density in asymptomatic menopausal women: correlation with clinical and sonographic findings. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000300006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate mammographic breast density in asymptomatic menopausal women in correlation with clinical and sonographic findings. MATERIALS AND METHODS: Mammograms and clinical and sonographic findings of 238 asymptomatic patients were retrospectively reviewed in the period from February/2022 to June/2006. The following variables were analyzed: mammographic density patterns, sonographic findings, patients' age, parity, body mass index and use of hormone replacement therapy. RESULTS: Age, parity and body mass index showed a negative correlation with breast density pattern, while use of hormone replacement therapy showed a positive correlation. Supplementary breast ultrasonography was performed in 103 (43.2%) patients. Alterations which could not be visualized at mammography were found in 34 (33%) of them, most frequently in women with breast density patterns 3 and 4. CONCLUSION: The authors concluded that breast density patterns were influenced by age, parity, body mass index and time of hormone replacement therapy. Despite not having found any malignant abnormality in the studied cases, the authors have observed a predominance of benign sonographic abnormalities in women with high breast density patterns and without mammographic abnormalities, proving the relevance of supplementary ultrasonography to identify breast lesions in such patients.
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226
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Zheng B, Sumkin JH, Zuley ML, Wang X, Klym AH, Gur D. Bilateral mammographic density asymmetry and breast cancer risk: a preliminary assessment. Eur J Radiol 2012; 81:3222-8. [PMID: 22579527 DOI: 10.1016/j.ejrad.2012.04.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 12/31/2022]
Abstract
To improve efficacy of breast cancer screening and prevention programs, it requires a risk assessment model with high discriminatory power. This study aimed to assess classification performance of using computed bilateral mammographic density asymmetry to predict risk of individual women developing breast cancer in near-term. The database includes 451 cases with multiple screening mammography examinations. The first (baseline) examinations of all case were interpreted negative. In the next sequential examinations, 187 cases developed cancer or surgically excised high-risk lesions, 155 remained negative (not-recalled), and 109 were recalled benign cases. From each of two bilateral cranio-caudal view images acquired from the baseline examination, we computed two features of average pixel value and local pixel value fluctuation. We then computed mean and difference of each feature computed from two images. When applying the computed features and other two risk factors (woman's age and subjectively rated mammographic density) to predict risk of cancer development, areas under receiver operating characteristic curves (AUC) were computed to evaluate the discriminatory/classification performance. The AUCs are 0.633±0.030, 0.535±0.036, 0.567±0.031, and 0.719±0.027 when using woman's age, subjectively rated, computed mean and asymmetry of mammographic density, to classify between two groups of cancer-verified and negative cases, respectively. When using an equal-weighted fusion method to combine woman's age and computed density asymmetry, AUC increased to 0.761±0.025 (p<0.05). The study demonstrated that bilateral mammographic density asymmetry could be a significantly stronger risk factor associated to the risk of women developing breast cancer in near-term than woman's age and assessed mean mammographic density.
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Affiliation(s)
- Bin Zheng
- Department of Radiology, University of Pittsburgh, Magee Womens Hospital, 3362 Fifth Ave, Pittsburgh, PA 15213, USA.
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227
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Yaghjyan L, Colditz GA, Rosner B, Tamimi RM. Mammographic breast density and breast cancer risk by menopausal status, postmenopausal hormone use and a family history of breast cancer. Cancer Causes Control 2012; 23:785-90. [PMID: 22438073 DOI: 10.1007/s10552-012-9936-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/02/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Few studies have investigated the association between breast density and breast cancer by a family history of breast cancer, menopausal status, and postmenopausal hormone use (PMH). We investigated if associations of breast density and breast cancer differ according to the status of these risk factors. METHODS This study included 1,481 incident breast cancer cases diagnosed within the Nurses' Health Study I and II cohorts and 2,779 matched controls. Breast density was measured from digitized film images with computerized techniques. Information on breast cancer risk factors was obtained prospectively from the biennial questionnaires before the date of the cancer diagnosis for cancer cases and their matched controls. The data were analyzed with logistic regression. RESULTS Breast cancer risk increased with increasing percent breast density in all strata (p for trend in all subsets <0.0001). The density-related risk of breast cancer was similar in women with and without a family history (OR = 4.00 [95 % CI 2.01-7.94] vs. 3.71 [95 % CI 2.79-4.94] for density ≥50 % vs. <10 %, p for interaction = 0.53). The magnitude of the association between density and breast cancer risk, however, appeared to be stronger in premenopausal women than in postmenopausal women without PMH history (OR = 5.49 [95 % CI 2.44-12.39] vs. 3.02 [95 % CI 1.62-5.63] for density ≥50 % vs. <10 %, p-heterogeneity = 0.17) and appeared to be stronger in postmenopausal women currently using hormones compared with postmenopausal women who never used PMH (OR = 4.50 [95 % CI 2.99-6.78] vs. 3.02, p-heterogeneity = 0.20) or with past hormone use (OR = 4.50 vs. 3.71 [95 % CI 1.90-7.23], p-heterogeneity = 0.23). CONCLUSIONS Findings on associations by menopausal status/hormone use are suggestive and should be examined in additional larger studies.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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228
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Lander MR, Tabár L. Automated 3-D breast ultrasound as a promising adjunctive screening tool for examining dense breast tissue. Semin Roentgenol 2012; 46:302-8. [PMID: 22035673 DOI: 10.1053/j.ro.2011.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marla R Lander
- Desert Comprehensive Breast Center, Desert Regional Medical Center, Palm Springs, CA, USA
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229
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Tagliafico A, Tagliafico G, Astengo D, Cavagnetto F, Rosasco R, Rescinito G, Monetti F, Calabrese M. Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software. Eur Radiol 2012; 22:1265-70. [DOI: 10.1007/s00330-012-2380-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 11/18/2011] [Accepted: 12/07/2011] [Indexed: 10/28/2022]
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230
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Ying X, Lin Y, Xia X, Hu B, Zhu Z, He P. A Comparison of Mammography and Ultrasound in Women with Breast Disease: A Receiver Operating Characteristic Analysis. Breast J 2012; 18:130-8. [DOI: 10.1111/j.1524-4741.2011.01219.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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231
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Chang DHE, Chen JH, Lin M, Bahri S, Yu HJ, Mehta RS, Nie K, Hsiang DJB, Nalcioglu O, Su MY. Comparison of breast density measured on MR images acquired using fat-suppressed versus nonfat-suppressed sequences. Med Phys 2012; 38:5961-8. [PMID: 22047360 DOI: 10.1118/1.3646756] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the difference of MR percent breast density measured from fat-suppressed versus nonfat-suppressed imaging sequences. METHODS Breast magnetic resonance imaging (MRI) with and without fat suppression was acquired from 38 subjects. Breasts were divided into subgroups of different morphological patterns ("central" and "intermingled" types). Breast volume, fibroglandular tissue volume, and percent density were measured. The results were compared using nonparametric statistical tests and regarded as significant at p < 0.05. RESULTS Breast volume, fibroglandular volume, and percent density between fat-suppressed and nonfat-suppressed sequences were highly correlated. Breast volumes measured on these two sequences were almost identical. Fibroglandular tissue volume and percent density, however, had small (<5%) yet significant differences between the two sequences-they were both higher on the fat-suppressed sequence. Intraobserver variability was within 4% for both sequences and different morphological types. The fibroglandular tissue volume measured on downsampled images showed a small (<5%) yet significant difference. CONCLUSIONS The measurement of breast density made on MRI acquired using fat-suppressed and nonfat-suppressed T1W images was about 5% difference, only slightly higher than the intraobserver variability of 3%-4%. When the density data from multiple centers were to be combined, evaluating the degree of difference is needed to take this difference into account.
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Affiliation(s)
- Daniel H-E Chang
- Department of Radiological Sciences, University of California, Irvine, CA 92697, USA
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232
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Burfeindt MJ, Behdad N, Van Veen BD, Hagness SC. Quantitative Microwave Imaging of Realistic Numerical Breast Phantoms Using an Enclosed Array of Multiband, Miniaturized Patch Antennas. IEEE ANTENNAS AND WIRELESS PROPAGATION LETTERS 2012; 11:1626-1629. [PMID: 25419189 PMCID: PMC4237205 DOI: 10.1109/lawp.2012.2236071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present a 3-D microwave breast imaging study in which we reconstruct the dielectric profiles of MRI-derived numerical breast phantoms from simulated array measurements using an enclosed array of multiband, miniaturized patch antennas. The array is designed to overcome challenges relating to the ill-posed nature of the inverse scattering system. We use a multifrequency formulation of the distorted Born iterative method to image four normal-tissue breast phantoms, each corresponding to a different density class. The reconstructed fibroglandular distributions are very faithful to the true distributions in location and basic shape. These results establish the feasibility of using an enclosed array of miniaturized, multiband patch antennas for quantitative microwave breast imaging.
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233
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Highnam R, Sauber N, Destounis S, Harvey J, McDonald D. Breast Density into Clinical Practice. BREAST IMAGING 2012. [DOI: 10.1007/978-3-642-31271-7_60] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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234
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Wang Y, Keller BM, Zheng Y, Acciavatti RJ, Gee JC, Maidment ADA, Kontos D. A Phantom Study for Assessing the Effect of Different Digital Detectors on Mammographic Texture Features. BREAST IMAGING 2012. [DOI: 10.1007/978-3-642-31271-7_78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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235
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Rzymski P, Wysocki PJ, Kycler W, Opala T. Correlation between insulin resistance and breast elasticity heterogeneity measured by shear wave elastography in premenopausal women - a pilot study. Arch Med Sci 2011; 7:1017-22. [PMID: 22328885 PMCID: PMC3264994 DOI: 10.5114/aoms.2011.26614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/15/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recent studies have demonstrated a strong correlation between obesity, insulin resistance, increased insulin and insulin-like growth factor levels and the risk of breast cancer. Our study was aimed at exploring correlations between glucose, insulin, insulin resistance, obesity and quantitatively estimated breast elasticity in healthy women. MATERIAL AND METHODS The pilot study included 37 premenopausal women aged 22-45 years who underwent B-mode sonography and real-time shear wave elastography. Blood was collected for fasting insulin and glucose, and HOMA insulin resistance index was calculated. RESULTS The mean elasticity of glandular and fatty tissue measured in both breasts was 12.5 ±3.5 kPa and 10.9 ±3.7 kPa respectively. Insulin levels did not correlate with glandular tissue elasticity (Rs=-0.23, p=0.15), but nearly correlated with fat tissue elasticity (Rs=-0.30, p=0.06), in outer quadrants significantly (Rs=-0.38, p=0.02). Interestingly, a strong correlation of insulin and insulin resistance with elasticity heterogeneity was found in fatty tissue (Rs=-0.59, p<0.001 and Rs=-0.60, p<0.001 respectively). The heterogeneity of fatty tissue but not glandular elasticity also correlated with body mass index. CONCLUSIONS Insulin levels and insulin resistance correlate with breast fat tissue heterogeneity, but their role in breast pathology remains unclear.
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Affiliation(s)
- Pawel Rzymski
- Department of Mother's and Child's Health, Poznan University of Medical Sciences, Gynaecological and Obstetrical University Hospital, Poznan, Poland
- Corresponding author: Pawel Rzymski MD, PhD, Department of Mother's and Child's Health, Poznan University of Medical Sciences, Gynaecological and Obstetrical University Hospital, 33 Polna, 60-535 Poznan, Poland, Phone: +48 605393096, Fax: +48 618419618. E-mail:
| | - Piotr J. Wysocki
- Department of Chemotherapy, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poland
| | - Witold Kycler
- Department of Oncological Surgery, Greater Poland Cancer Centre, Poznan, Poland
| | - Tomasz Opala
- Department of Mother's and Child's Health, Poznan University of Medical Sciences, Gynaecological and Obstetrical University Hospital, Poznan, Poland
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236
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Vitamin D and mammographic breast density: a systematic review. Cancer Causes Control 2011; 23:1-13. [PMID: 21984232 DOI: 10.1007/s10552-011-9851-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/28/2011] [Indexed: 12/31/2022]
Abstract
Studies suggest a protective relationship between Vitamin D and breast cancer risk. Several studies assessed the association of Vitamin D with mammographic breast density, a known and strong breast cancer risk factor. Understanding the potential role of Vitamin D in the modification of breast density might open new avenues in breast cancer prevention. This systematic review summarizes published studies that investigated the association between Vitamin D and mammographic breast density and offers suggestions for strategies to advance our scientific knowledge.
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237
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Boyd NF, Melnichouk O, Martin LJ, Hislop G, Chiarelli AM, Yaffe MJ, Minkin S. Mammographic Density, Response to Hormones, and Breast Cancer Risk. J Clin Oncol 2011; 29:2985-92. [PMID: 21709206 DOI: 10.1200/jco.2010.33.7964] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Percent mammographic density (PMD) is a strong risk factor for breast cancer that changes in response to changes in hormone exposure. We have examined the magnitude of the association of hormone exposure with PMD according to subsequent breast cancer risk. Methods In three case-control studies, with 1,164 patient cases and 1,155 controls nested in cohorts of women screened with mammography, we examined the association of PMD measured in the baseline mammogram with risk of breast cancer in the following 1 to 8 years (mean, 3 years), according to use of oral contraceptives (OCs) in premenopausal women, menopause, and hormone therapy (HT) in postmenopausal women. All statistical comparisons are adjusted for age and other risk factors. Results In premenopausal women who later developed breast cancer (patient cases), PMD was 5.3% greater in past users of OCs than in nonusers (P = .06). In controls, OC users had 2% less density than nonusers (P = .44; test for interaction P = .06). The difference in PMD between premenopausal and postmenopausal women for patient cases was 8.5% (P < .001) and for controls, 3.9% (P = .01; test for interaction P = .03). In postmenopausal women, PMD was 6% greater in patients who used HT than in never users (P < .001). Controls who used HT had 1.6% greater PMD (P = .26) than never users (test for interaction P = .001). Differences in PMD resulted mainly from differences in the dense area of the mammogram. Conclusion Differences in PMD associated with differences in hormone exposure were greater in women who later developed breast cancer than in controls in each of the hormone exposures examined.
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Affiliation(s)
- Norman F. Boyd
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Olga Melnichouk
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Lisa J. Martin
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Greg Hislop
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Anna M. Chiarelli
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Martin J. Yaffe
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Salomon Minkin
- Norman F. Boyd, Olga Melnichouk, and Lisa J. Martin, The Campbell Family Institute for Breast Cancer Research; Norman F. Boyd, Olga Melnichouk, Lisa J. Martin, and Salomon Minkin, Ontario Cancer Institute; Anna M. Chiarelli, Cancer Care Ontario; Martin J. Yaffe, Sunnybrook Health Sciences Centre, Toronto, Ontario; and Greg Hislop, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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238
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Yaghjyan L, Colditz GA, Collins LC, Schnitt SJ, Rosner B, Vachon C, Tamimi RM. Mammographic breast density and subsequent risk of breast cancer in postmenopausal women according to tumor characteristics. J Natl Cancer Inst 2011; 103:1179-89. [PMID: 21795664 DOI: 10.1093/jnci/djr225] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Few studies that investigated the associations between breast density and subsequent breast cancer according to tumor characteristics have produced inconclusive findings. We aimed to determine whether the associations between breast density and subsequent breast cancer varied by tumor characteristics. METHODS We included 1042 postmenopausal women diagnosed with breast cancer between June 1, 1989, and June 30, 2004, and 1794 matched control subjects from the Nurses' Health Study, an ongoing prospective cohort study of 121 701 registered female nurses across the United States. Breast density was estimated from digitized images using computerized techniques. Information on breast cancer risk factors was obtained prospectively from biennial questionnaires before the date of cancer diagnosis for case subjects and matched control subjects. Polychotomous logistic regression was used to assess associations of breast density with tumor subtypes based on invasiveness, histology, size, grade, receptor status, and involvement of lymph nodes. All tests of statistical significance were two-sided. RESULTS The risk of breast cancer increased progressively with increase in percent breast density (P(trend) < .001). Women with higher breast density (≥50%) showed a 3.39-fold (odds ratio = 3.39, 95% confidence interval = 2.46 to 4.68) increased risk of breast cancer compared with women with lower breast density (<10%). The associations between breast density and breast cancer risk were stronger for in situ compared with invasive tumors (P(heterogeneity) < .01), high-grade compared with low-grade tumors (P(heterogeneity) = .02), larger (>2 cm) compared with smaller (≤2 cm) tumors (P(heterogeneity) < .01), and estrogen receptor-negative compared with estrogen receptor-positive tumors (P(heterogeneity) = .04). There were no differences in associations by tumor histology, involvement of lymph nodes, and progesterone receptor and HER2 status (P(heterogeneity) > .05). CONCLUSIONS The findings suggest that higher mammographic density is associated with more aggressive tumor characteristics and also with in situ tumors.
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Affiliation(s)
- Lusine Yaghjyan
- Department of Surgery, Division of Public Health Sciences, Washington University in St Louis School of Medicine, St Louis, MO, USA
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239
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Kontos D, Ikejimba LC, Bakic PR, Troxel AB, Conant EF, Maidment ADA. Analysis of parenchymal texture with digital breast tomosynthesis: comparison with digital mammography and implications for cancer risk assessment. Radiology 2011; 261:80-91. [PMID: 21771961 DOI: 10.1148/radiol.11100966] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To correlate the parenchymal texture features at digital breast tomosynthesis (DBT) and digital mammography with breast percent density (PD), an established breast cancer risk factor, in a screening population of women. MATERIALS AND METHODS This HIPAA-compliant study was approved by the institutional review board. Bilateral DBT images and digital mammograms from 71 women (mean age, 54 years; age range, 34-75 years) with negative or benign findings at screening mammography were retrospectively collected from a separate institutional review board-approved DBT screening trial (performed from July 2007 to March 2008) in which all women had given written informed consent. Parenchymal texture features of skewness, coarseness, contrast, energy, homogeneity, and fractal dimension were computed from the retroareolar region. Principal component analysis (PCA) was applied to obtain orthogonal texture components. Mammographic PD was estimated with software. Correlation analysis and multiple linear regression with generalized estimating equations were performed to determine the association between texture features and breast PD. Regression was adjusted for age to determine the independent association of texture to breast PD when age was also considered as a predictor variable. RESULTS Texture feature correlations to breast PD were stronger with DBT than with digital mammography. Statistically significant correlations (P < .001) were observed for contrast (r = 0.48), energy (r = -0.47), and homogeneity (r = -0.56) at DBT and for contrast (r = 0.26), energy (r = -0.26), and homogeneity (r = -0.33) at digital mammography. Multiple linear regression analysis of PCA texture components as predictors of PD also demonstrated significantly stronger associations with DBT. The association was strongest when age was also considered as a predictor of PD (R² = 0.41 for DBT and 0.28 for digital mammography; P < .001). CONCLUSION Parenchymal texture features are more strongly correlated to breast PD in DBT than in digital mammography. The authors' long-term hypothesis is that parenchymal texture analysis with DBT will result in quantitative imaging biomarkers that can improve the estimation of breast cancer risk.
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Affiliation(s)
- Despina Kontos
- Department of Radiology, University of Pennsylvania Health System, Philadelphia PA 19104-4206, USA.
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240
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Kennedy G, Markert M, Alexander JR, Avisar E. Predictive value of BI-RADS classification for breast imaging in women under age 50. Breast Cancer Res Treat 2011; 130:819-23. [PMID: 21748292 DOI: 10.1007/s10549-011-1669-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/29/2011] [Indexed: 11/27/2022]
Abstract
In this study, we assessed the positive-predictive value (PPV) of mammography and/or ultrasonography in women age 50 based on recommendations for biopsies and final pathology results. We performed a retrospective analysis of all mammography and ultrasonography reports issued from 9/2005 to 1/2007 resulting in biopsy among women aged 18-50 at a large county hospital. Data included demographics, imaging modality, breast density, type of finding, BI-RADS, and final pathology. Results were compared to women aged >50 at the same institution. Four hundred and seventy-five biopsies in 395 patients were reviewed. The PPV of BI-RADS 3 (n = 11) was 9.1%, BI-RADS 4 (n = 440) 5.9%, and BI-RADS 5 (n = 24) 66.7%. Forty three (9%) were malignant, of which 31 (6.5%) were invasive carcinomas and 12 (2.5%) were noninvasive. None of the biopsies on patients aged <30 were malignant. Recommended biopsies based on mammography alone were malignant in 20.2% (20/99) compared to 3.4% (7/205) for ultrasonography alone, and 8.9% (15/168) for both mammography and ultrasonography. Suspicious calcifications were malignant in 25% compared to 6.8% for masses/nodules and 3.6% for cysts. Lesions larger than 2 cm are more likely to be malignant (11.8%) than lesions between 1 and 2 cm (3.6%) or below 1 cm (4.3%). The PPV of the current screening modalities diminishes markedly in women under the age of 50 and even more below the age of 40. Calcifications and masses larger than 2 cm should be biopsied, but the current BI-RADS criteria may benefit from revision for other findings in young patients.
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Affiliation(s)
- Gannon Kennedy
- Miller School of Medicine, University of Miami, Miami, FL, USA
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241
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Abstract
Evidence that aromatase expression in tumor-associated breast stroma is elevated, provides a rationale for use of aromatase inhibitors (AIs) in breast cancer treatment. However, regulation of local aromatase expression in cancer-free breast stroma is poorly understood. Recent clinical work indicates that stromal cells in dense breast tissue tend to express higher levels of aromatase than their counterpart from non-dense tissue. Consistent with the clinical observation, our cell culture-based study indicated that cell density, cell shape, and extracellular matrix (ECM) significantly induced stromal aromatase expression via a distinct signal transduction pathway. In addition, we identified a number of cell surface markers that are commonly associated with aromatase-expressing stromal cells. As mammographic density is one of the strongest and most prevalent risk factors for breast cancer, these findings provide a potential mechanistic link between alterations in tissue composition of dense breast tissue and increased stromal aromatase expression. Further exploration of the in vitro model system may advance understanding of an important problem in breast cancer biology.
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Affiliation(s)
| | | | - Howard Wang
- Division of Plastic Surgery, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78245, USA
| | | | - Rong Li
- Corresponding author: Department of Molecular Medicine, Institute of Biotechnology, 15355 Lambda Drive, University of Texas, Health Science Center at San Antonio, San Antonio, TX 78245, Telephone: 210-567-7215, Fax: 210-567-7324,
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242
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Heine JJ, Cao K, Rollison DE. Calibrated measures for breast density estimation. Acad Radiol 2011; 18:547-55. [PMID: 21371912 DOI: 10.1016/j.acra.2010.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/18/2010] [Accepted: 12/09/2010] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Breast density is a significant breast cancer risk factor measured from mammograms. Evidence suggests that the spatial variation in mammograms may also be associated with risk. We investigated the variation in calibrated mammograms as a breast cancer risk factor and explored its relationship with other measures of breast density using full field digital mammography (FFDM). MATERIALS AND METHODS A matched case-control analysis was used to assess a spatial variation breast density measure in calibrated FFDM images, normalized for the image acquisition technique variation. Three measures of breast density were compared between cases and controls: (a) the calibrated average measure, (b) the calibrated variation measure, and (c) the standard percentage of breast density (PD) measure derived from operator-assisted labeling. Linear correlation and statistical relationships between these three breast density measures were also investigated. RESULTS Risk estimates associated with the lowest to highest quartiles for the calibrated variation measure were greater in magnitude (odds ratios: 1.0 [ref.], 3.5, 6.3, and 11.3) than the corresponding risk estimates for quartiles of the standard PD measure (odds ratios: 1.0 [ref.], 2.3, 5.6, and 6.5) and the calibrated average measure (odds ratios: 1.0 [ref.], 2.4, 2.3, and 4.4). The three breast density measures were highly correlated, showed an inverse relationship with breast area, and related by a mixed distribution relationship. CONCLUSION The three measures of breast density capture different attributes of the same data field. These preliminary findings indicate the variation measure is a viable automated method for assessing breast density. Insights gained by this work may be used to develop a standard for measuring breast density.
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243
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Heine JJ, Cao K, Rollison DE, Tiffenberg G, Thomas JA. A quantitative description of the percentage of breast density measurement using full-field digital mammography. Acad Radiol 2011; 18:556-64. [PMID: 21474058 DOI: 10.1016/j.acra.2010.12.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES Breast density is a significant breast cancer risk factor that is measured from mammograms. However, uncertainty remains in both understanding its underlying physical properties as it relates to the breast and determining the optimal method for its measurement. A quantitative description of the information captured by the standard operator-assisted percentage of breast density (PD) measure was developed using full-field digital mammography (FFDM) images that were calibrated to adjust for interimage acquisition technique differences. MATERIALS AND METHODS The information captured by the standard PD measure was quantified by developing a similar measure of breast density (PD(c)) from calibrated mammograms automatically by applying a static threshold to each image. The specific threshold was estimated by first sampling the probability distributions for breast tissue in calibrated mammograms. A percent glandular (PG) measure of breast density was also derived from calibrated mammograms. The PD, PD(c), and PG breast density measures were compared using both linear correlation (R) and quartile odds ratio measures derived from a matched case-control study. RESULTS The standard PD measure is an estimate of the number of pixel values above a fixed idealized x-ray attenuation fraction. There was significant correlation (P < .0001) between the PD(c)-PD (r = 0.78), PD(c)-PG (r = 0.87), and PD-PG (r = 0.71) measures of breast density. Risk estimates associated with the lowest to highest quartiles for the PD(c) measure (odds ratio [OR]: 1.0 ref., 3.4, 3.6, and 5.6), and the standard PD measure (OR 1.0 ref., 2.9, 4.8, and 5.1) were similar and greater than that of the calibrated PG measure (OR 1.0 ref., 2.0, 2.4, and 2.4). CONCLUSIONS The information captured by the standard PD measure was quantified as it relates to calibrated mammograms and used to develop an automated method for measuring breast density. These findings represent an initial step for developing an automated measure built on an established calibration platform. A fully developed automated measure may be useful for both research- and clinical-based risk applications.
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244
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Moon WK, Shen YW, Huang CS, Luo SC, Kuzucan A, Chen JH, Chang RF. Comparative study of density analysis using automated whole breast ultrasound and MRI. Med Phys 2011; 38:382-9. [PMID: 21361206 DOI: 10.1118/1.3523617] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the measurements of breast density using three-dimensional (3-D) automated whole breast ultrasound (ABUS) and magnetic resonance imaging (MRI). METHODS In this study, 3-D ABUS and MRI breast images were obtained from 40 patients-bilaterally in 27 patients and unilaterally (due to operation in the contralateral breast) in 13 patients, To differentiate the fibroglandular and fatty tissues in ABUS and MRI images, the fuzzy C-mean classifier was used. Calculated values for percent density and breast volume from the two modalities were compared to and correlated with linear regression analysis. Intraoperator and interoperator variations among eight cases were evaluated to verify the consistency of the density analysis. RESULTS Mean percent density and breast volume derived from ABUS (17.63 +/- 11.87% and 418.30 +/- 132.97 cm3, respectively) and MRI images (23.79 +/- 16.62% and 544.90 +/- 207.41 cm3) demonstrated good correlation (R = 0.917 and R = 0.884). Intraoperator and interoperator analyses yielded slightly larger coefficients of variation for percent density and breast volume in ABUS compared to MRI. However, the differences were not statistically significant. CONCLUSIONS ABUS and MRI showed high correlation for breast density and breast volume quantification. Both modalities could provide useful breast density information to physicians.
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Affiliation(s)
- Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
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245
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Kotre CJ. Statistical analysis of mammographic breast composition measurements: towards a quantitative measure of relative breast cancer risk. Br J Radiol 2011; 84:153-60. [PMID: 21081576 PMCID: PMC3473849 DOI: 10.1259/bjr/40806022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/06/2010] [Accepted: 02/04/2010] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A number of studies have identified the relationship between the visual appearance of high breast density at mammography and an increased risk of breast cancer. With the advent of digital mammography and the promise of routine measurements of parameters associated with breast composition, the possibility arises of using breast composition in a quantitative manner to predict relative breast cancer risk. Previous measurements have shown that the average proportion of glandular and adipose tissue within the breast varies with both age and breast size. In order to be able to identify individual women with an unusually high volume of glandular tissue, it will therefore be necessary to make comparisons with a disease-free population matched for age and breast size. METHODS A large number of breast glandular thickness measurements were analysed to investigate the statistics of breast composition across a disease-free population as a test of a suitable methodology for relative risk estimation. The large data set is also used to revisit the trends in breast composition used in the current UK method of breast radiation dosimetry. RESULTS It is demonstrated that a non-linear transformation can be used to produce normal statistical distributions, suitable for producing a standardised "Z-score" for breast composition. CONCLUSION A standard "Z-score" approach to identify women with unusually glandular breasts is recommended and so provide a basis for cancer risk estimations.
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Affiliation(s)
- C J Kotre
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, UK.
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Cigler T, Richardson H, Yaffe MJ, Fabian CJ, Johnston D, Ingle JN, Nassif E, Brunner RL, Wood ME, Pater JL, Hu H, Qi S, Tu D, Goss PE. A randomized, placebo-controlled trial (NCIC CTG MAP.2) examining the effects of exemestane on mammographic breast density, bone density, markers of bone metabolism and serum lipid levels in postmenopausal women. Breast Cancer Res Treat 2011; 126:453-61. [PMID: 21221773 DOI: 10.1007/s10549-010-1322-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/19/2010] [Indexed: 01/14/2023]
Abstract
We hypothesized that exemestane (EXE) would reduce mammographic breast density and have unique effects on biomarkers of bone and lipid metabolism. Healthy postmenopausal women were randomized to EXE (25 mg daily) or placebo (PLAC) for 12 months and followed for a total of 24 months. The primary endpoint was change in percent breast density (PD) between the baseline and 12-month mammograms and secondary endpoints were changes in serum lipid levels, bone biomarkers, and bone mineral density (BMD). Ninety-eight women were randomized (49 to EXE; 49 to PLAC) and 65 had PD data at baseline and 12 months. Among women treated with EXE, PD was not significantly changed from baseline at 6, 12, or 24 months and was not different from PLAC. EXE was associated with significant percentage increase from baseline in N-telopeptide at 12 months compared with PLAC. No differences in percent change from baseline in BMD (lumbar spine and femoral neck) were observed between EXE and PLAC at either 12 or 24 months. Patients on EXE had a significantly larger percent decrease in total cholesterol than in the PLAC arm at 6 months and in HDL cholesterol at 3, 6, and 12 months. No significant differences in percent change in LDL or triglycerides were noted at any time point between the two treatment arms. EXE administered for 1 year to healthy postmenopausal women did not result in significant changes in mammographic density. A reversible increase in the bone resorption marker N-telopeptide without significant change in bone specific alkaline phosphatase or BMD during the 12 months treatment period and 1 year later was noted. Changes in lipid parameters on this trial were modest and reversible.
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Affiliation(s)
- T Cigler
- Weill Cornell Medical College, New York, NY, USA
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247
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Abstract
Mammographic density (MD) has consistently been found as one of the strongest breast cancer risk factors. In our study, both qualitative and quantitative density measurements were performed in a hospital-based group of premenopausal women before and after first full-term pregnancy providing an opportunity for direct evaluation of the effects of one pregnancy on MD. Mammograms were obtained from 23 women before and after first full-term pregnancy and from 28 nulliparous controls. MD was determined by a standard qualitative assessment method using the Breast Imaging Reporting and Data System, and a quantitative computer-based threshold method (0-100%). The mean age at mammography before and after pregnancy was 31 and 34 years, respectively, with a mean difference of 40 months between mammographies. The quantitative density assessment showed a significant reduction in relative MD after pregnancy of 12 percentage points (8.6-15.4), compared with 3.1 (0.0-6.2) in the nulliparous control group (P<0.001). A reduction in MD of more than 10% was seen in 52% of the patients, compared with 18% of the controls. The qualitative density assessment confirmed a reduction in MD after pregnancy by one Breast Imaging Reporting and Data System category (P=0.02). This longitudinal study showed that MD can be influenced by one full-term pregnancy. This effect was seen with both quantitative and qualitative assessment methods. It may be hypothesized that breast cancer risk reduction associated with pregnancy is mediated through a direct reduction of MD, and MD assessment might be incorporated in individualizing risk assessment and prevention.
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248
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A Tree Classifier for Automatic Breast Tissue Classification Based on BIRADS Categories. PATTERN RECOGNITION AND IMAGE ANALYSIS 2011. [DOI: 10.1007/978-3-642-21257-4_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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249
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Teller P, Kramer RK. Management of the asymptomatic BRCA mutation carrier. APPLICATION OF CLINICAL GENETICS 2010; 3:121-31. [PMID: 23776357 PMCID: PMC3681169 DOI: 10.2147/tacg.s8882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current management of an asymptomatic BRCA mutation carrier includes early initiation and intensive cancer screening in combination with risk reduction strategies. The primary objectives of these interventions are earlier detection and cancer prevention to increase quality of life and prolonged survival. Existing recommendations are often based on the consensus of experts as there are few, supportive, randomized control trials. Management strategies for unaffected patients with BRCA mutations are continually redefined and customized as more evidence-based knowledge is acquired with regard to current intervention efficacy, mutation-related histology, and new treatment modalities. This review provides an outline of current, supported management principles, and interventions in the care of the asymptomatic BRCA mutation carrier. Topics covered include surveillance modalities and risk reduction achieved through behavioral modification, chemoprevention, and prophylactic surgery.
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Affiliation(s)
- Paige Teller
- Surgical Oncology, Medical University of South Carolina, Charleston, SC, USA
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250
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Kuchiki M, Hosoya T, Fukao A. Assessment of Breast Cancer Risk Based on Mammary Gland Volume Measured with CT. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2010; 4:57-64. [PMID: 21151862 PMCID: PMC2999513 DOI: 10.4137/bcbcr.s5248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We investigated the relationship between mammary gland volume (MGV) of the breast as measured with three-dimensional chest computed tomography (CT) and breast cancer risk. Univariate analysis was used to assess the relationship between MGV and known risk factors in 427 healthy women. A case control study (97 cases and 194 controls) was conducted to assess breast cancer risk. MGV was significantly smaller for postmenopausal women than for premenopausal women, and was significantly larger for women with a family history of breast cancer than for women without. MGV, body mass index (BMI), and rate of family history of breast cancer were significantly higher among breast cancer patients than among healthy women, and number of deliveries was significantly lower among breast cancer patients. In postmenopausal women, age at menarche was significantly younger for breast cancer patients. MGV correlated well with breast cancer risk factors. The highest odds ratio was 4.9 for premenopausal women with the largest MGV. Regardless of menopausal status, the greater the MGV, the higher the odds ratio. Our results constitute the first reliable data on the relationship between MGV and breast cancer obtained through exact volume analysis.
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