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Logan J, Kennedy PJ, Catchpoole D. A review of the machine learning datasets in mammography, their adherence to the FAIR principles and the outlook for the future. Sci Data 2023; 10:595. [PMID: 37684306 PMCID: PMC10491669 DOI: 10.1038/s41597-023-02430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/31/2023] [Indexed: 09/10/2023] Open
Abstract
The increasing rates of breast cancer, particularly in emerging economies, have led to interest in scalable deep learning-based solutions that improve the accuracy and cost-effectiveness of mammographic screening. However, such tools require large volumes of high-quality training data, which can be challenging to obtain. This paper combines the experience of an AI startup with an analysis of the FAIR principles of the eight available datasets. It demonstrates that the datasets vary considerably, particularly in their interoperability, as each dataset is skewed towards a particular clinical use-case. Additionally, the mix of digital captures and scanned film compounds the problem of variability, along with differences in licensing terms, ease of access, labelling reliability, and file formats. Improving interoperability through adherence to standards such as the BIRADS criteria for labelling and annotation, and a consistent file format, could markedly improve access and use of larger amounts of standardized data. This, in turn, could be increased further by GAN-based synthetic data generation, paving the way towards better health outcomes for breast cancer.
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Affiliation(s)
- Joe Logan
- Alixir Technologies Pty Ltd, Sydney, NSW, Australia.
- Australian Artificial Intelligence Institute, University of Technology Sydney, Sydney, NSW, Australia.
| | - Paul J Kennedy
- Australian Artificial Intelligence Institute, University of Technology Sydney, Sydney, NSW, Australia
| | - Daniel Catchpoole
- Australian Artificial Intelligence Institute, University of Technology Sydney, Sydney, NSW, Australia
- The Tumour Bank, The Children's Cancer Research Unit, Kids Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Neuropathy Score Reporting and Data System (NS-RADS): MRI Reporting Guideline of Peripheral Neuropathy Explained and Reviewed. Skeletal Radiol 2022; 51:1909-1922. [PMID: 35478047 DOI: 10.1007/s00256-022-04061-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
A standardized guideline and scoring system should be used for the MR imaging diagnosis of peripheral neuropathy. The MR imaging-based Neuropathy Score Reporting and Data System (NS-RADS) is a newly devised classification system (in press in AJR) that can be used to communicate both type and severity of peripheral neuropathy in the light of clinical history and examination findings. The spectrum of neuropathic conditions and peripheral nerve disorders covered in this system includes nerve injury, entrapment, neoplasm, diffuse neuropathy, and post-interventional states. This classification system also describes the temporal MR imaging appearances of regional muscle denervation changes. This review article is based on the multicenter validation study pre-published in American journal of Roentgenology and discusses technical considerations of optimal MR imaging for peripheral nerve evaluation and discusses the NS-RADS classification and its severity scales with illustration of conditions that fall under each classification. The readers can gain knowledge of the NS-RADS classification system and learn to apply it in their practices for improved inter-disciplinary communications and timely patient management.
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Marthay K, Yahya MM, Tengku Din TADAA, Wan Zain WZ, Haron J, Wong MPK, Ramely R, Wan Mokhter WMM, Hashim Isa Merican SR, Mohd Hashim MN. A Five-Year Review of the Outcomes of Breast Imaging Reporting and Data System 4 Lesions in Hospital Universiti Sains Malaysia. Cureus 2022; 14:e22757. [PMID: 35371885 PMCID: PMC8971048 DOI: 10.7759/cureus.22757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: The Breast Imaging Reporting and Data System (BI-RADS) lexicon used in reporting breast imaging has several categories with specific positive predictive values for breast cancer. Among those, BI-RADS 4 is associated with a wider range of risk for breast cancer, which makes the decision for biopsy difficult. The study aim was to determine the malignancy rate and clinical outcomes of BI-RADS 4 lesions in Hospital Universiti Sains Malaysia (HUSM) for a period of five years. Methods: This was a retrospective study of patients diagnosed by mammographic or ultrasonographic findings with BI-RADS 4 breast lesions in HUSM, Kelantan from July 2015 to June 2020. Data were collected from the medical records and an electronic database. Patients with BI-RADS 4 lesions who underwent biopsy and had a known tissue diagnosis were included in this study. The data was used to calculate the malignancy rate and associated positive predictive factors for breast cancer associated with BI-RADS 4 lesions. Results: From the mammography and ultrasonography performed at HUSM from July 2015 to June 2020, a total of 256 lesions were categorized as BI-RADS 4. However, only 198 BI-RADS 4 lesions underwent biopsy and were included in the study. Of these 198 lesions, 26.8% were malignant on histopathological examination of the biopsy samples. Simple logistic regression analysis showed that age, diabetes mellitus, hypertension, number of parity, and certain mammogram findings were significantly associated with breast cancer. Invasive breast cancer was the most common type. Fibrocystic disease was the most common benign pathology, followed by fibroadenoma. Conclusion: The malignancy rate of BI-RADS 4 lesions in HUSM was similar to previously reported rates. A thorough evaluation of positive predictive factors and careful selection of patients for biopsy in BI-RADS 4 lesions will minimize unwanted biopsies and associated patient anxiety, in addition to reducing the health care burden.
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Ucar H, Kacar E, Karaca R. The Contribution of a Solid Breast Mass Gray-Scale Histographic Analysis in Ascertaining a Benign-Malignant Differentiation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221078205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to determine the efficiency of a fat-lesion histographic analysis (FLHA) to make a benign-malignant differentiation, for patients with a breast mass. In addition, it was important to examine the relationship between FLHA rates and Breast Imaging–Reporting and Data System (BI-RADS) scoring. Materials and Methods: This was a retrospective study conducted by examining the breast ultrasonograms (BUS) and histopathologic data of 76 women, having at least one solid breast mass. The patients were grouped according to their histopathologic diagnoses and BUS BI-RADS scores. The recorded digital gray-scale images were transferred to a workstation to quantitatively measure tissue echogenicity. The breast masses and adjacent adipose tissue were evaluated using the ImageJ analysis program, and gray-scale histographic analysis values were generated. The FLHA rate was determined by dividing the fat tissue histographic value by the mass-lesion histographic value. Statistical analysis was performed using this value as well as the patients’ histopathologic data and BUS BI-RADS score. Results: A complementary effect was noted using FLHA rates with the BUS BI-RADS criteria, and a statistically significant difference was detected between benign and malignant histopathology groups ( P < .001). Similarly, the malignant histopathologic diagnosis with BI-RADS 4 and benign histopathologic diagnosis with BI-RADS 4 groups were related ( P < .001). The correlation between BI-RADS criteria and FLHA rates demonstrated a significant difference between BI-RADS 3 and BI-RADS 5 ( P < .001), and BI-RADS 4 and BI-RADS 5 for FLHA rates ( P = .002). Conclusion: It was determined that using the FLHA rate was a complement to the BUS BI-RADS criteria. In this cohort, there was a statistically significant difference in predicting possible malignancy in all BI-RADS classes.
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Affiliation(s)
- Huseyin Ucar
- Department of Radiology, Tekirdag State Hospital, Tekirdag, Turkey
| | - Emre Kacar
- Department of Radiology, Doruk Private Hospital, Bursa, Turkey
| | - Rukan Karaca
- Department of Radiology, Darende State Hospital, Malatya, Turkey
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Oza P, Sharma P, Patel S, Bruno A. A Bottom-Up Review of Image Analysis Methods for Suspicious Region Detection in Mammograms. J Imaging 2021; 7:190. [PMID: 34564116 PMCID: PMC8466003 DOI: 10.3390/jimaging7090190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is one of the most common death causes amongst women all over the world. Early detection of breast cancer plays a critical role in increasing the survival rate. Various imaging modalities, such as mammography, breast MRI, ultrasound and thermography, are used to detect breast cancer. Though there is a considerable success with mammography in biomedical imaging, detecting suspicious areas remains a challenge because, due to the manual examination and variations in shape, size, other mass morphological features, mammography accuracy changes with the density of the breast. Furthermore, going through the analysis of many mammograms per day can be a tedious task for radiologists and practitioners. One of the main objectives of biomedical imaging is to provide radiologists and practitioners with tools to help them identify all suspicious regions in a given image. Computer-aided mass detection in mammograms can serve as a second opinion tool to help radiologists avoid running into oversight errors. The scientific community has made much progress in this topic, and several approaches have been proposed along the way. Following a bottom-up narrative, this paper surveys different scientific methodologies and techniques to detect suspicious regions in mammograms spanning from methods based on low-level image features to the most recent novelties in AI-based approaches. Both theoretical and practical grounds are provided across the paper sections to highlight the pros and cons of different methodologies. The paper's main scope is to let readers embark on a journey through a fully comprehensive description of techniques, strategies and datasets on the topic.
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Affiliation(s)
- Parita Oza
- Computer Science and Engineering Department, School of Technology, Pandit Deendayal Energy University, Gandhinagar 382007, India; (P.S.); (S.P.)
| | - Paawan Sharma
- Computer Science and Engineering Department, School of Technology, Pandit Deendayal Energy University, Gandhinagar 382007, India; (P.S.); (S.P.)
| | - Samir Patel
- Computer Science and Engineering Department, School of Technology, Pandit Deendayal Energy University, Gandhinagar 382007, India; (P.S.); (S.P.)
| | - Alessandro Bruno
- Department of Computing and Informatics, Bournemouth University, Poole, Dorset BH12 5BB, UK
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Chong KH, Huang KF, Kuo HW, Tzeng IS, Chen JH. Detection rate of breast malignancy of needle localization biopsy of breast microcalcification. Tzu Chi Med J 2021; 33:275-281. [PMID: 34386366 PMCID: PMC8323655 DOI: 10.4103/tcmj.tcmj_191_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The current study aimed to retrospectively assess the cancer detection rate of needle localization biopsy of breast microcalcifications undetectable on sonography. MATERIALS AND METHODS Patients who underwent mammography-guided needle localization biopsy of breast microcalcifications undetectable on sonography from January 2005 to December 2017 were included in the study. Patients with incomplete medical records were excluded from the study. Patient mammograms were categorized using the Breast Imaging-Reporting and Data System (BI-RADS) assessment criteria. The percentages of benign and malignant lesions were determined by pathological examination of surgically recovered specimens. Correlation between preoperative imaging assessment and final diagnosis was investigated, and the complications associated with the procedures were recorded. RESULTS A total of 301 needle-localized biopsies were performed under mammographic guidance. The mean age of the patients was 58.18 ± 7.73 years. The overall ductal carcinoma in situ (DCIS) and cancer detection rate was 23.3%. The proportion of patients with BI-RADS 0 category and undergoing second mammography was higher in the DCIS and cancer group. A total of 227 patients did not undergo second mammography. Of these patients, 70 demonstrated BI-RADS 4 category, 34 were diagnosed with DCIS, and 5 were diagnosed with breast cancer during subsequent follow-up. CONCLUSION Needle-localized excision of microcalcifications undetectable on sonography has high detection rate for early stage of breast cancer with low risk of associated complications. Regular mammography is a satisfactory follow-up tool for female patients with microcalcifications in the breasts. Additional studies should be performed to compare between needle-localized excision and vacuum-assisted breast biopsy.
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Affiliation(s)
- Kian-Hwee Chong
- Division of General Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Kuo-Feng Huang
- Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsiu-Wen Kuo
- Department of Radiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Jia-Hui Chen
- Division of General Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Kang C, Yu X, Wang SH, Guttery DS, Pandey HM, Tian Y, Zhang YD. A Heuristic Neural Network Structure Relying on Fuzzy Logic for Images Scoring. IEEE TRANSACTIONS ON FUZZY SYSTEMS : A PUBLICATION OF THE IEEE NEURAL NETWORKS COUNCIL 2021; 29:34-45. [PMID: 33408453 PMCID: PMC7116542 DOI: 10.1109/tfuzz.2020.2966163] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Traditional deep learning methods are sub-optimal in classifying ambiguity features, which often arise in noisy and hard to predict categories, especially, to distinguish semantic scoring. Semantic scoring, depending on semantic logic to implement evaluation, inevitably contains fuzzy description and misses some concepts, for example, the ambiguous relationship between normal and probably normal always presents unclear boundaries (normal - more likely normal - probably normal). Thus, human error is common when annotating images. Differing from existing methods that focus on modifying kernel structure of neural networks, this study proposes a dominant fuzzy fully connected layer (FFCL) for Breast Imaging Reporting and Data System (BI-RADS) scoring and validates the universality of this proposed structure. This proposed model aims to develop complementary properties of scoring for semantic paradigms, while constructing fuzzy rules based on analyzing human thought patterns, and to particularly reduce the influence of semantic conglutination. Specifically, this semantic-sensitive defuzzier layer projects features occupied by relative categories into semantic space, and a fuzzy decoder modifies probabilities of the last output layer referring to the global trend. Moreover, the ambiguous semantic space between two relative categories shrinks during the learning phases, as the positive and negative growth trends of one category appearing among its relatives were considered. We first used the Euclidean Distance (ED) to zoom in the distance between the real scores and the predicted scores, and then employed two sample t test method to evidence the advantage of the FFCL architecture. Extensive experimental results performed on the CBIS-DDSM dataset show that our FFCL structure can achieve superior performances for both triple and multiclass classification in BI-RADS scoring, outperforming the state-of-the-art methods.
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Affiliation(s)
- Cheng Kang
- School of Informatics, the University of Leicester, Leicester, United Kingdom
| | - Xiang Yu
- School of Informatics, the University of Leicester, Leicester, United Kingdom
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Chang RWJ, Chuang SL, Hsu CY, Yen AMF, Wu WYY, Chen SLS, Fann JCY, Tabar L, Smith RA, Duffy SW, Chiu SYH, Chen HH. Precision Science on Incidence and Progression of Early-Detected Small Breast Invasive Cancers by Mammographic Features. Cancers (Basel) 2020; 12:cancers12071855. [PMID: 32664200 PMCID: PMC7408735 DOI: 10.3390/cancers12071855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022] Open
Abstract
The aim was to evaluate how the inter-screening interval affected the performance of screening by mammographic appearances. This was a Swedish retrospective screening cohort study with information on screening history and mammography features in two periods (1977–1985 and 1996–2010). The pre-clinical incidence and the mean sojourn time (MST) for small breast cancer allowing for sensitivity by mammographic appearances were estimated. The percentage of interval cancer against background incidence (I/E ratio) was used to assess the performance of mammography screening by different inter-screening intervals. The sensitivity-adjusted MSTs (in years) were heterogeneous with mammographic features, being longer for powdery and crushed stone-like calcifications (4.26, (95% CI, 3.50–5.26)) and stellate masses (3.76, (95% CI, 3.15–4.53)) but shorter for circular masses (2.65, (95% CI, 2.06–3.55)) in 1996–2010. The similar trends, albeit longer MSTs, were also noted in 1977–1985. The I/E ratios for the stellate type were 23% and 32% for biennial and triennial screening, respectively. The corresponding figures were 32% and 43% for the circular type and 21% and 29% for powdery and crushed stone-like calcifications, respectively. Mammography-featured progressions of small invasive breast cancer provides a new insight into personalized quality assurance, surveillance, treatment and therapy of early-detected breast cancer.
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Affiliation(s)
- Rene Wei-Jung Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; (R.W.-J.C.); (C.-Y.H.)
| | - Shu-Lin Chuang
- Department of Medical Research, National Taiwan University Hospital, Taipei City 100, Taiwan;
| | - Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; (R.W.-J.C.); (C.-Y.H.)
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City 110, Taiwan; (A.M.-F.Y.); (S.L.-S.C.)
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, 90187 Umeå, Sweden;
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City 110, Taiwan; (A.M.-F.Y.); (S.L.-S.C.)
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, College of Healthcare Management, Kainan University, Taoyuan City 338, Taiwan;
| | - Laszlo Tabar
- Department of Mammography, Falun Central Hospital, 791823 Falun, Sweden;
| | - Robert A. Smith
- Center for Cancer Screening, American Cancer Society, Atlanta, GA 30303, USA;
| | - Stephen W. Duffy
- Centre for Cancer Prevention, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK;
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan City 333, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- Correspondence: (S.Y.-H.C.); (H.-H.C.); Tel.: +886-3-2118800 (ext. 5250) (S.Y.-H.C.); +886-2-33668033 (H.-H.C.)
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; (R.W.-J.C.); (C.-Y.H.)
- Correspondence: (S.Y.-H.C.); (H.-H.C.); Tel.: +886-3-2118800 (ext. 5250) (S.Y.-H.C.); +886-2-33668033 (H.-H.C.)
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Stereotactic biopsy results of patient series with non-palpable breast lesions in our hospital. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.683171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hayashi Y. New unified insights on deep learning in radiological and pathological images: Beyond quantitative performances to qualitative interpretation. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Understanding Clinical Mammographic Breast Density Assessment: a Deep Learning Perspective. J Digit Imaging 2019; 31:387-392. [PMID: 28932980 DOI: 10.1007/s10278-017-0022-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Mammographic breast density has been established as an independent risk marker for developing breast cancer. Breast density assessment is a routine clinical need in breast cancer screening and current standard is using the Breast Imaging and Reporting Data System (BI-RADS) criteria including four qualitative categories (i.e., fatty, scattered density, heterogeneously dense, or extremely dense). In each mammogram examination, a breast is typically imaged with two different views, i.e., the mediolateral oblique (MLO) view and cranial caudal (CC) view. The BI-RADS-based breast density assessment is a qualitative process made by visual observation of both the MLO and CC views by radiologists, where there is a notable inter- and intra-reader variability. In order to maintain consistency and accuracy in BI-RADS-based breast density assessment, gaining understanding on radiologists' reading behaviors will be educational. In this study, we proposed to leverage the newly emerged deep learning approach to investigate how the MLO and CC view images of a mammogram examination may have been clinically used by radiologists in coming up with a BI-RADS density category. We implemented a convolutional neural network (CNN)-based deep learning model, aimed at distinguishing the breast density categories using a large (15,415 images) set of real-world clinical mammogram images. Our results showed that the classification of density categories (in terms of area under the receiver operating characteristic curve) using MLO view images is significantly higher than that using the CC view. This indicates that most likely it is the MLO view that the radiologists have predominately used to determine the breast density BI-RADS categories. Our study holds a potential to further interpret radiologists' reading characteristics, enhance personalized clinical training to radiologists, and ultimately reduce reader variations in breast density assessment.
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Costantini R, Sardellone A, Marino C, Giamberardino MA, Innocenti P, Napolitano AM. Vacuum-Assisted Core Biopsy (Mammotome) for the Diagnosis of Non-Palpable Breast Lesions: Four-Year Experience in an Italian Center. TUMORI JOURNAL 2019; 91:351-4. [PMID: 16277103 DOI: 10.1177/030089160509100413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Microinvasive biopsy techniques are increasingly employed in the diagnostic assessment of non-palpable breast lesions (NPBLs). This study reports the four-year experience of an Italian surgical center in the evaluation of the diagnostic effectiveness versus adverse effects of vacuum-assisted core biopsy (Mammotome). Methods 314 NPBLs with a dubious ultrasound and/or radiographic appearance were subjected to mammography-guided (86) or ultrasound-guided (228) Mammotome biopsy. Results The procedure could be completed and was diagnostic in 305 cases (P <0.0001). Adverse events were transient lightheadedness. in two cases and moderate bleeding in three cases. Histological processing of the biopsies showed 227 cases of benign disease (74.42%), 68 cases of carcinoma (20 carcinomas in situ and 48 infiltrating carcinomas) (22.29%), nine cases of atypical ductal hyperplasia (2.95%) and one atypical lobular hyperplasia (0.33%). Only 12 patients reported mild discomfort relative to the procedure. The difference between the number of patients reporting discomfort and that of patients reporting no discomfort at all was highly significant (P <0.0001). Conclusions The results confirm that Mammotome biopsy is a highly effective procedure for the diagnosis of NPBLs, with minimal negative effects.
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Hayashi Y. The Right Direction Needed to Develop White-Box Deep Learning in Radiology, Pathology, and Ophthalmology: A Short Review. Front Robot AI 2019; 6:24. [PMID: 33501040 PMCID: PMC7806076 DOI: 10.3389/frobt.2019.00024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/27/2019] [Indexed: 11/13/2022] Open
Abstract
The popularity of deep learning (DL) in the machine learning community has been dramatically increasing since 2012. The theoretical foundations of DL are well-rooted in the classical neural network (NN). Rule extraction is not a new concept, but was originally devised for a shallow NN. For about the past 30 years, extensive efforts have been made by many researchers to resolve the “black box” problem of trained shallow NNs using rule extraction technology. A rule extraction technology that is well-balanced between accuracy and interpretability has recently been proposed for shallow NNs as a promising means to address this black box problem. Recently, we have been confronting a “new black box” problem caused by highly complex deep NNs (DNNs) generated by DL. In this paper, we first review four rule extraction approaches to resolve the black box problem of DNNs trained by DL in computer vision. Next, we discuss the fundamental limitations and criticisms of current DL approaches in radiology, pathology, and ophthalmology from the black box point of view. We also review the conversion methods from DNNs to decision trees and point out their limitations. Furthermore, we describe a transparent approach for resolving the black box problem of DNNs trained by a deep belief network. Finally, we provide a brief description to realize the transparency of DNNs generated by a convolutional NN and discuss a practical way to realize the transparency of DL in radiology, pathology, and ophthalmology.
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Affiliation(s)
- Yoichi Hayashi
- Department of Computer Science, Meiji University, Kawasaki, Japan
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14
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Ultrasound-Guided Vacuum-Assisted Biopsy in Small Breast: A Cost-Saving Solution. Clin Breast Cancer 2019; 19:e352-e357. [DOI: 10.1016/j.clbc.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/01/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022]
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15
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Characteristics of Mammographic Breast Density and Associated Factors for Chinese Women: Results from an Automated Measurement. JOURNAL OF ONCOLOGY 2019; 2019:4910854. [PMID: 31015834 PMCID: PMC6444251 DOI: 10.1155/2019/4910854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 11/18/2022]
Abstract
Background Characteristics of mammographic density for Chinese women are understudied. This study aims to identify factors associated with mammographic density in China using a quantitative method. Methods Mammographic density was measured for a total of 1071 (84 with and 987 without breast cancer) women using an automatic algorithm AutoDensity. Pearson tests examined relationships between density and continuous variables and t-tests compared differences of mean density values between groupings of categorical variables. Linear models were built using multiple regression. Results Percentage density and dense area were positively associated with each other for cancer-free (r=0.487, p<0.001) and cancer groups (r=0.446, p<0.001), respectively. For women without breast cancer, weight and BMI (p<0.001) were found to be negatively associated (r=-0.237, r=-0.272) with percentage density whereas they were found to be positively associated (r=0.110, r=0.099) with dense area; age at mammography was found to be associated with percentage density (r=-0.202, p<0.001) and dense area (r=-0.086, p<0.001) but did not add any prediction within multivariate models; lower percentage density was found within women with secondary education background or below compared to women with tertiary education. For women with breast cancer, percentage density demonstrated similar relationships with that of cancer-free women whilst breast area was the only factor associated with dense area (r=0.739, p<0.001). Conclusion This is the first time that mammographic density was measured by a quantitative method for women in China and identified associations should be useful to health policy makers who are responsible for introducing effective models of breast cancer prevention and diagnosis.
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Alomaim W, O'Leary D, Ryan J, Rainford L, Evanoff M, Foley S. Variability of Breast Density Classification Between US and UK Radiologists. J Med Imaging Radiat Sci 2019; 50:53-61. [DOI: 10.1016/j.jmir.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/09/2018] [Accepted: 11/27/2018] [Indexed: 12/22/2022]
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Wintermark M, Li Y, Ding VY, Xu Y, Jiang B, Ball RL, Zeineh M, Gean A, Sanelli P. Neuroimaging Radiological Interpretation System for Acute Traumatic Brain Injury. J Neurotrauma 2018; 35:2665-2672. [DOI: 10.1089/neu.2017.5311] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | - Ying Li
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | - Victoria Y. Ding
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, California
| | - Yingding Xu
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | - Bin Jiang
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | - Robyn L. Ball
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, California
| | - Michael Zeineh
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | - Alisa Gean
- Department of Radiology, Neuroradiology Section, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Pina Sanelli
- Department of Radiology, Northwell Hofstra School of Medicine, Northwell Health, Manhasset, New York
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Alba LH, Díaz S, Gamboa O, Poveda C, Henao A, Perry F, Duggan C, Gil F, Murillo R. Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia. Prev Med 2018; 115:19-25. [PMID: 30092313 DOI: 10.1016/j.ypmed.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50-69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3-99.3) and 99.4% (95%CI 99.2-99.6). CBE sensitivity was 39.1% (95%CI 37.9-40.3) and specificity 83.4% (95%CI 82.6-84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.
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Affiliation(s)
- Luz Helena Alba
- Department of Preventive and Social Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sandra Díaz
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Oscar Gamboa
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - César Poveda
- Servicio de Imaginología, Instituto Nacional de Cancerología, Bogotá, Colombia; Facultad de Medicina, Universidad Nacional, Bogotá, Colombia
| | - Andrés Henao
- Radiología, Centro de Enfermedades Mamarias, Bogotá, Colombia
| | - Fernando Perry
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fabián Gil
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Raúl Murillo
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France; Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia.
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Kim J, Kim EK, Kim MJ, Moon HJ, Yoon JH. "Category 4A" microcalcifications: how should this subcategory be applied to microcalcifications seen on mammography? Acta Radiol 2018; 59:147-153. [PMID: 28490180 DOI: 10.1177/0284185117709036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The BI-RADS provides descriptors for microcalcifications based on morphology and distribution. However, the descriptor for category 4A microcalcifications is not specified in the 5th BI-RADS nor in the prior editions. Purpose To investigate how the category 4A assessment is applied to suspicious microcalcifications, and the appropriate descriptors for category 4A assessment for microcalcifications seen on mammography. Material and Methods From June 2008 to November 2011, 296 women with 305 suspicious microcalcifications that were assessed as BI-RADS category 4A, who underwent imaging-guided biopsy or surgery, were included. Mammograms were reviewed and imaging features were analyzed according to the morphology and distribution descriptors of the 5th edition of BI-RADS. Pathological results were considered as the reference standard. Positive predictive values were calculated and compared between morphology and distribution descriptors. Results The overall positive predictive value (PPV) of category 4A microcalcifications was 17.7% (54/305). Most common descriptors for category 4A microcalcifications were amorphous morphology (73.1%) and grouped distribution (71.1%). PPVs of individual morphology descriptors were as follows: amorphous = 7.2%; coarse heterogeneous = 12.8%; fine pleomorphic or fine linear/fine linear branching = 91.4% ( P < 0.001). PPVs of distribution descriptors were as follows: regional = 13.2%; grouped = 16.1%; linear/segmental = 54.5% ( P < 0.001). For morphology and distribution descriptors combinations, PPVs for amorphous/regional and amorphous/grouped microcalcifications were 6.8% and 6.9%, while PPVs of other combinations were higher than 10%, respectively. Conclusion Common descriptors used in category 4A assessment for microcalcifications are amorphous morphology and grouped distribution. PPV of amorphous/regional and amorphous/grouped microcalcifications were suitable for category 4A assessment.
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Affiliation(s)
- Jihee Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Meenan C, Erickson B, Knight N, Fossett J, Olsen E, Mohod P, Chen J, Langer SG. Workflow Lexicons in Healthcare: Validation of the SWIM Lexicon. J Digit Imaging 2017; 30:255-266. [DOI: 10.1007/s10278-016-9935-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kanat NB, Tuncel M, Aksoy T, Fırat A, Demirkazık F, Onat D, Çağlar Tuncalı M, Caner BE. Comparison of wire-guided localization and radio-guided occult lesionlocalization in preoperative localization of nonpalpable breast lesions. Turk J Med Sci 2016; 46:1829-1837. [PMID: 28081335 DOI: 10.3906/sag-1507-162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 03/26/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Breast lesions that are not palpable on physical examination but considered suspicious for malignancy on mammography or ultrasonography should be marked before surgery. Wire-guided localization (WGL) is the most frequently used method for preoperative marking of nonpalpable breast lesions (NPBLs). An alternative is marking by a radioactive agent (radio-guided occult lesion localization; ROLL). The present study aimed to compare WGL and ROLL for preoperative marking. MATERIALS AND METHODS The study included 25 patients marked by ROLL and 11 patients marked by WGL. The groups were compared in terms of patient and lesion characteristics, method-related characteristics, hospital stay duration, complications, cosmetic outcomes, and rate of correct marking. RESULTS Suspicious lesions were marked with a success rate of 95.6% by ROLL and 100% by WGL. Complications and pain sensation rates were found significantly lower in the ROLL group compared to WGL. Although ROLL was considered more advantageous in terms of hospital stay duration, positive surgical margins, cosmetic outcomes, and excision duration, the differences between the groups were not statistically significant. CONCLUSION ROLL, which is a simple, comfortable, and reliable method, could be used as an alternative to the WGL in preoperative marking of NPBLs.
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Affiliation(s)
- Nazım Barış Kanat
- Department of Nuclear Medicine, Mersin State Hospital, Mersin, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tamer Aksoy
- Department of Nuclear Medicine, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Ayşegül Fırat
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Figen Demirkazık
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Demirali Onat
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Çağlar Tuncalı
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Biray Emine Caner
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Friedman P, Kerwin L, Chung J. Clinical Outcomes of Mammographic BI-RADS 3 Lesions in the Community Hospital Setting. Can Assoc Radiol J 2016; 67:313-317. [PMID: 27523446 DOI: 10.1016/j.carj.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/17/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Per the Breast Imaging Reporting and Data System (BI-RADS) manual, a lesion designated as BI-RADS 3 should have less than a 2% chance of becoming malignancy. With this study, we evaluated the outcome of patients given a BI-RADS 3 designation in the community hospital. Specifically, whether our cancer detection rate for BI-RADS 3 lesions was less than 2% and comparable to rates obtained at other institutions. METHODS The records of 1037 patients given a BI-RADS 3 on screening mammogram were reviewed over a 1-year period between May 2007 and May 2008. A total of 142 of these patients were lost to follow-up, leaving 885 patients. Some of these patients had more than 1 BI-RADS 3 lesion during this study period, yielding a total of 923 BI-RADS 3 lesions to evaluate out of the 885 patients remaining. Of these, 478 of the patients' lesions were biopsied. The pathology was then reviewed to determine whether the lesions were cancerous. RESULTS Only 6 of the 882 lesions initially classified as a BI-RADS 3 were later diagnosed as cancer, or 0.65% of the study population. The positive predictive value of receiving a BI-RADS 3 was 99.3%, which demonstrates a high accuracy in predicting that a lesion is not cancerous. CONCLUSION Most lesions that are diagnosed as a BI-RADS 3 have a very low probability of eventually being diagnosed as cancer. The findings from this study are comparable to studies performed at other institutions.
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Affiliation(s)
- Paul Friedman
- Breast Center at Morristown Medical Center, Morristown, New Jersey, USA
| | - Lauren Kerwin
- Breast Center at Morristown Medical Center, Morristown, New Jersey, USA.
| | - Jean Chung
- Breast Center at Morristown Medical Center, Morristown, New Jersey, USA
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Multi-parametric MRI and PI-RADS (V1) scoring system: New inception in cancer prostate diagnosis to evaluate diagnostic performance of different score combinations. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Diz J, Marreiros G, Freitas A. Applying Data Mining Techniques to Improve Breast Cancer Diagnosis. J Med Syst 2016; 40:203. [DOI: 10.1007/s10916-016-0561-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/25/2016] [Indexed: 11/25/2022]
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Lee J, Park HY, Jung JH, Kim WW, Hwang SO, Kwon TJ, Chung JH, Bae Y. Non-stereotactic method involving combination of ultrasound-guided wire localization and vacuum-assisted breast biopsy for microcalcification. Gland Surg 2016; 5:300-5. [PMID: 27294037 DOI: 10.21037/gs.2015.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stereotactic breast biopsy is a standard intervention for evaluation of "microcalcification-only" lesions. However, an expensive stereotactic device and radiologic expertise are necessary for this procedure. We herein report a non-stereotactic technique involving the combination of wire localization and vacuum-assisted breast biopsy (VABB) under ultrasound (US) guidance. METHODS Twenty-two consecutive patients with category 3 or 4a microcalcification only as shown by mammography underwent the above-mentioned non-stereotactic combination method involving US-guided wire localization and VABB. The location of the microcalcification was measured by manual stereotaxis, and the microcalcification was confirmed by specimen mammography after the procedure. RESULTS The mean number ± standard deviation of removed cores and calcified cores was 28.4±13.4 and 2.2±0.9, respectively. In one case, the procedure was repeated 3 times. The histologic diagnoses were fibrocystic change (n=14), fibroadenoma (n=4), sclerosing adenosis (n=1), usual ductal hyperplasia (n=2), and atypical ductal hyperplasia (n=1). CONCLUSIONS "Microcalcification-only" breast lesions can be easily evaluated with the combination of non-stereotactic US-guided wire localization and VABB. This would be an effective diagnostic technique for breast lesion which reveals only microcalcification.
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Affiliation(s)
- Jeeyeon Lee
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ho Yong Park
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Hyang Jung
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Wan Wook Kim
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung Ook Hwang
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Taek Ju Kwon
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Ho Chung
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Youngtae Bae
- 1 Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea ; 2 Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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The inter-observer variability of breast density scoring between mammography technologists and breast radiologists and its effect on the rate of adjuvant ultrasound. Eur J Radiol 2016; 85:957-62. [PMID: 27130056 DOI: 10.1016/j.ejrad.2016.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/05/2016] [Accepted: 02/22/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE This study assesses the inter-observer variability of mammographic breast density scoring (BDS) between technologists and radiologists and evaluates the effect of technologist patient referral on the load of adjuvant ultrasounds. MATERIALS AND METHODS In this IRB approved study, a retrospective analysis of 503 prospectively acquired, random mammograms was performed between January and March 2014. Each mammogram was evaluated for BDS independently and blindly by both the performing technologist and the interpreting radiologist. Statistical calculation of the Spearman correlation coefficient and weighted kappa were obtained to evaluate the inter-observer variability between technologists and radiologists and to examine whether it relates to the technologist's seniority or women's age. The effect on the load of adjuvant ultrasounds was evaluated. RESULTS 10 mammography technologists and 7 breast radiologists participated in this study. BDS agreement levels between technologists and radiologists were in the fair to moderate range (kappa values: 0.3-0.45, Spearman coefficient values: 0.59-0.65). The technologists markedly over-graded the density compared to the radiologists in all the subsets evaluated. Comparison between low and high-density groups demonstrated a similar trend of over-grading by technologists, who graded 51% of the women as having dense breasts (scores 3-4) compared to 27% of the women graded as such by the radiologists. This trend of over grading breast density by technologists was unrelated to the women's age or to the technologists' seniority. CONCLUSION Mammography technologists over-grade breast density. Technologists' referral to an adjuvant ultrasound leads to redundant ultrasound studies, unnecessary breast biopsies, costs and increased patient anxiety.
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Abstract
More than other medical discipline, radiology is marked by technical innovation and continuous development, as well as the optimization of the underlying physical principles. In this respect, several trends that will crucially change and develop radiology over the next decade can be observed. Through the use of ever faster computer tomography, which also shows an ever-decreasing radiation exposure, the "workhorse" of radiology will have an even greater place and displace conventional X‑ray techniques further. In addition, hybrid imaging, which is based on a combination of nuclear medicine and radiological techniques (keywords: PET/CT, PET/MRI) will become much more established and, in particular, will improve oncological imaging further, allowing increasingly individualized imaging for specific tracers and techniques of functional magnetic resonance imaging for a particular tumour. Future radiology will be strongly characterized by innovations in the software and Internet industry, which will enable new image viewing and processing methods and open up new possibilities in the context of the organization of radiological work.
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Imaging Breast Density: Established and Emerging Modalities. Transl Oncol 2015; 8:435-45. [PMID: 26692524 PMCID: PMC4700291 DOI: 10.1016/j.tranon.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022] Open
Abstract
Mammographic density has been proven as an independent risk factor for breast cancer. Women with dense breast tissue visible on a mammogram have a much higher cancer risk than women with little density. A great research effort has been devoted to incorporate breast density into risk prediction models to better estimate each individual’s cancer risk. In recent years, the passage of breast density notification legislation in many states in USA requires that every mammography report should provide information regarding the patient’s breast density. Accurate definition and measurement of breast density are thus important, which may allow all the potential clinical applications of breast density to be implemented. Because the two-dimensional mammography-based measurement is subject to tissue overlapping and thus not able to provide volumetric information, there is an urgent need to develop reliable quantitative measurements of breast density. Various new imaging technologies are being developed. Among these new modalities, volumetric mammographic density methods and three-dimensional magnetic resonance imaging are the most well studied. Besides, emerging modalities, including different x-ray–based, optical imaging, and ultrasound-based methods, have also been investigated. All these modalities may either overcome some fundamental problems related to mammographic density or provide additional density and/or compositional information. The present review article aimed to summarize the current established and emerging imaging techniques for the measurement of breast density and the evidence of the clinical use of these density methods from the literature.
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Huang N, Chen J, Xue J, Yu B, Chen Y, Yang W, Shao Z, Wu J. Breast Sclerosing Adenosis and Accompanying Malignancies: A Clinicopathological and Imaging Study in a Chinese Population. Medicine (Baltimore) 2015; 94:e2298. [PMID: 26656378 PMCID: PMC5008523 DOI: 10.1097/md.0000000000002298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sclerosing adenosis (SA) is a less common histopathological lesion of the breast that can coexist with proliferative lesions as well as malignancies. We aimed to analyze the clinicopathological characteristics of SA and to investigate the radiological features of SA.Patients who underwent breast surgery at our institute from 2007 to 2013 were retrospectively reviewed. A total of 815 breasts (722 patients) were included in the final analysis. Synchronous bilateral SA was defined as the detection of another SA arising in the contralateral breast within 1 month after surgery for the initial breast lesion. Baseline characteristics, imaging records (ultrasonography, mammography, and magnetic resonance imaging [MRI]), and pathology were included in the analysis.The median age at diagnosis was 47 years old. The majority of patients had unilateral non-Bc-SA (457/722). Among 102 patients with bilateral SA, 78.4% were diagnosed synchronously. In total, 26 patients suffered from synchronous bilateral breast cancer. Upon final pathological investigation, 226 cases were SA involving breast cancer (Bc-SA), most (56.2%) of which were ductal carcinoma in situ (DCIS). In addition, lobular carcinoma in situ (LCIS) and diseases that involved LCIS also comprised up to 11.1% of cases. The majority of SA cases (405; 49.7%) had no obvious symptoms except for imaging changes in mammography or ultrasound. Compared with non-Bc-SA cases, Bc-SA cases were more likely to exhibit features of mass (32.8% vs. 28.6%) and architectural distortion (20.4% vs. 13.0%) on mammography. Ultrasonography, mammography, and MRI revealed unsatisfactory sensitivity and specificity to differentiate Bc-SA from non-Bc-SA. MRI exhibited the highest sensitivity and lowest specificity, whereas the specificity of mammography was as low as 50.0%.A tendency for synchronous bilaterality in both Bc-SA and non-Bc-SA was noted. DCIS was the most commonly observed malignancy involved in Bc-SA. Although most patients with SA were asymptomatic, the ability of imaging studies to accurately differentiate non-Bc-SA from Bc-SA remained unsatisfactory.
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Affiliation(s)
- Naisi Huang
- From the Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China (NH, JC, JX, ZS, JW); Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (BY, WY); Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (YC); Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China (NH, JC, JX, BY, YC, WY, ZS, JW); and Collaborative Innovation Center for Cancer Medicine, Guangdong, China (JW)
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Cheung YC, Juan YH, Ueng SH, Lo YF, Huang PC, Lin YC, Chen SC. Assessment of Breast Specimens With or Without Calcifications in Diagnosing Malignant and Atypia for Mammographic Breast Microcalcifications Without Mass: A STARD-Compliant Diagnostic Accuracy Article. Medicine (Baltimore) 2015; 94:e1832. [PMID: 26496323 PMCID: PMC4620838 DOI: 10.1097/md.0000000000001832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Presence of microcalcifications within the specimens frequently signifies a successful attempt of stereotactic vacuum-assisted breast biopsy (VABB) in obtaining a pathologic diagnosis of the breast microcalcifications. In this study, the authors aimed to assess and compare the accuracy and consistency of calcified or noncalcified specimens obtained from same sites of sampling on isolated microcalcifications without mass in diagnosing high-risk and malignant lesions. To the best of our knowledge, an individual case-based prospective comparison has not been reported.With the approval from institutional review board of our hospital (Chang Gung Memorial Hospital), the authors retrospectively reviewed all clinical cases of stereotactic VABBs on isolated breast microcalcifications without mass from our database. The authors included those having either surgery performed or had clinical follow-up of at least 3 years for analysis. All the obtained specimens with or without calcification were identified using specimen radiographs and separately submitted for pathologic evaluation. The concordance of diagnosis was assessed for both atypia and malignant lesions.A total of 390 stereotactic VABB procedures (1206 calcified and 1456 noncalcified specimens) were collected and reviewed. The consistent rates between calcified and noncalcified specimens were low for atypia and malignant microcalcifications (44.44% in flat epithelial atypia, 46.51% in atypical ductal hyperplasia, 55.73% in ductal carcinoma in situ, and 71.42% in invasive ductal carcinoma). The discordance in VABB diagnoses indicated that 41.33% of malignant lesions would be misdiagnosed by noncalcified specimens. Furthermore, calcified specimens showed higher diagnostic accuracy of breast cancer as compared with the noncalcified specimens (91.54 % versus 69.49%, respectively). The evaluation of both noncalcified specimens and calcified specimens did not show improvement of diagnostic accuracy as compared with evaluating calcified specimens alone (91.54% versus 91.54%, respectively).The high prevalence of diagnostic discordance between the calcified and noncalcified specimens indicated the higher value of calcified specimens in diagnosing atypia and malignant microcalcifications. Noncalcified specimens did not provide additional diagnostic benefit from this study. The separation of calcified and noncalcified specimens may facilitate more focused interpretation from pathologists among the large number of specimens.
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Affiliation(s)
- Yun-Chung Cheung
- From the Department of Medical Imaging and Intervention (Y-CC, Y-HJ, P-CH, Y-CL), Department of Pathology (S-HU), Department of Surgery (Y-FL, S-CC); and Medical College of Chang Gung University, Taoyuan, Taiwan (Y-CC, Y-HJ, S-HU, Y-FL, P-CH, Y-CL, S-CC)
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Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis. Eur Radiol 2015; 26:1082-9. [DOI: 10.1007/s00330-015-3904-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/02/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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Correlation between EGFR mutation status and computed tomography features in patients with advanced pulmonary adenocarcinoma. J Thorac Imaging 2015; 29:357-63. [PMID: 25303964 DOI: 10.1097/rti.0000000000000116] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To correlate computed tomography (CT) imaging features and epidermal growth factor receptor (EGFR) mutation status in patients with advanced lung adenocarcinoma. MATERIALS AND METHODS Patients with advanced pulmonary adenocarcinoma who were diagnosed between January 1, 2009 and December 31, 2011 and who had available chest CT and their tumors analyzed for EGFR mutations at a university hospital were enrolled in this retrospective study. Two radiologists independently evaluated the CT images and recorded the target lesion's size, shape, margin, density, and the presence or absence of an air bronchogram and calcification. RESULTS One hundred and forty-nine patients were enrolled into this study (66 men, 83 women), with a mean age of 63±11 years (range 32 to 89 y). Seventy-eight (52.3%) patients had EGFR mutations. The tumors in the patients harboring no EGFR mutations (EGFR wild type) were larger than in those whose tumors harbored EGFR mutations (P=0.01). An irregular shape was more common in the tumors with wild-type EGFR (P=0.01), and an oval shape was more common in tumors with EGFR mutations. Tumors with exon 21 mutations were larger than those with exon 19 deletions (P=0.02). Air bronchograms were more common in tumors with exon 19 deletions than in those with wild-type EGFR or exon 21 mutations (P=0.004 and 0.01, respectively). Calcification was more common in the tumors with wild-type EGFR than in those with EGFR mutations (P=0.03). CONCLUSIONS Adenocarcinomas with wild-type EGFR were significantly associated with larger tumors and an irregular shape. In particular, calcification was more common in the tumors with wild-type EGFR than in those with EGFR mutations. In addition, air bronchograms were more common in the tumors with exon 19 deletions.
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Muller BG, Shih JH, Sankineni S, Marko J, Rais-Bahrami S, George AK, de la Rosette JJMCH, Merino MJ, Wood BJ, Pinto P, Choyke PL, Turkbey B. Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging. Radiology 2015; 277:741-50. [PMID: 26098458 DOI: 10.1148/radiol.2015142818] [Citation(s) in RCA: 267] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate accuracy and interobserver variability with the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 for detection of prostate cancer at multiparametric magnetic resonance (MR) imaging in a biopsy-naïve patient population. MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by the local ethics committee, and written informed consent was obtained from all patients for use of their imaging and histopathologic data in future research studies. In 101 biopsy-naïve patients with elevated prostate-specific antigen levels who underwent multiparametric MR imaging of the prostate and subsequent transrectal ultrasonography (US)-MR imaging fusion-guided biopsy, suspicious lesions detected at multiparametric MR imaging were scored by five readers who were blinded to pathologic results by using to the newly revised PI-RADS and the scoring system developed in-house. Interobserver agreement was evaluated by using κ statistics, and the correlation of pathologic results with each of the two scoring systems was evaluated by using the Kendall τ correlation coefficient. RESULTS Specimens of 162 lesions in 94 patients were sampled by means of transrectal US-MR imaging fusion biopsy. Results for 87 (54%) lesions were positive for prostate cancer. Kendall τ values with the PI-RADS and the in-house-developed scoring system, respectively, at T2-weighted MR imaging in the peripheral zone were 0.51 and 0.17 and in the transitional zone, 0.45 and -0.11; at diffusion-weighted MR imaging, 0.42 and 0.28; at dynamic contrast material-enhanced MR imaging, 0.23 and 0.24, and overall suspicion scores were 0.42 and 0.49. Median κ scores among all possible pairs of readers for PI-RADS and the in-house-developed scoring system, respectively, for T2-weighted MR images in the peripheral zone were 0.47 and 0.15; transitional zone, 0.37 and 0.07; diffusion-weighted MR imaging, 0.41 and 0.57; dynamic contrast-enhanced MR imaging, 0.48 and 0.41; and overall suspicion scores, 0.46 and 0.55. CONCLUSION Use of the revised PI-RADS provides moderately reproducible MR imaging scores for detection of clinically relevant disease.
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Affiliation(s)
- Berrend G Muller
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Joanna H Shih
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Sandeep Sankineni
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Jamie Marko
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Soroush Rais-Bahrami
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Arvin Koruthu George
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Jean J M C H de la Rosette
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Maria J Merino
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Bradford J Wood
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Peter Pinto
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Peter L Choyke
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
| | - Baris Turkbey
- From the Molecular Imaging Program (B.G.M., S.S., P.L.C., B.T.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.H.S.), Urologic Oncology Branch (S.R.B., A.G., P.P.), Laboratory of Pathology (M.J.M.), and Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands (B.G.M., J.J.M.C.H.d.l.R.); and Department of Radiology and Radiological Sciences, Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, Md (J.M.)
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Kim SY, Kim HY, Kim EK, Kim MJ, Moon HJ, Yoon JH. Evaluation of malignancy risk stratification of microcalcifications detected on mammography: a study based on the 5th edition of BI-RADS. Ann Surg Oncol 2015; 22:2895-901. [PMID: 25608770 DOI: 10.1245/s10434-014-4362-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The 5th edition of Breast Imaging Reporting and Data System subdivides suspicious calcifications into two categories: 4B-amorphous, coarse heterogeneous, and fine pleomorphic calcifications; 4C-fine linear or fine linear branching calcifications. We investigated whether these revised categories are appropriate for malignancy risk stratification. METHODS We studied 246 patients (mean age 48.2 years) with suspicious microcalcifications detected on mammography who underwent stereotactic biopsy (n = 154) or surgical excisional biopsy with preoperative mammogram-guided needle localization (n = 92). Pre-biopsy mammograms were reviewed retrospectively, and imaging features were analyzed according to the revised morphology and distribution descriptors. Pathological results of stereotactic biopsy and surgical excision were considered, with the surgical results being the reference standard. Positive predictive values (PPVs) were calculated and compared using the χ (2) test or Fisher's exact test. RESULTS Overall PPV of suspicious microcalcifications was 22.4 %. PPVs of morphology descriptors were as follows: amorphous 7.9 %, coarse heterogeneous 17.8 %, fine pleomorphic 63.2 %, fine linear/fine linear branching 100 % (p < 0.001). PPVs of distribution descriptors were as follows: regional 8.8 %, grouped 14.3 %, linear 87.5 %, segmental 63.6 % (p < 0.001). For morphology and distribution descriptors combinations, PPVs for amorphous/regional and amorphous/grouped microcalcifications were 4.2 and 7.6 %, resepectively. The PPV for fine pleomorphic/linear or segmental was 93.8 %. CONCLUSIONS Subcategorization of morphology descriptors for suspicious microcalcifications is needed because of the different PPVs for amorphous, coarse heterogeneous, and fine pleomorphic microcalcifications. Combining morphology and distribution descriptors for suspicious microcalcifications provides accurate risk stratification.
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Affiliation(s)
- Soo-Yeon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea
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Matrai C, D'Alfonso TM, Pharmer L, Drotman MB, Simmons RM, Shin SJ. Advocating Nonsurgical Management of Patients With Small, Incidental Radial Scars at the Time of Needle Core Biopsy: A Study of 77 Cases. Arch Pathol Lab Med 2015; 139:1137-42. [DOI: 10.5858/arpa.2014-0550-oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain.
Objective
To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management.
Design
Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed.
Results
Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001).
Conclusions
No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.
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Affiliation(s)
| | | | | | | | | | - Sandra J. Shin
- From the Departments of Pathology and Laboratory Medicine (Drs Matrai, D'Alfonso, and Shin), Breast Surgery (Drs Pharmer and Simmons), and Radiology-Division of Women's Imaging (Dr Drotman), Weill Cornell Medical College, New York, New York. Drs Matrai and D'Alfonso contributed equally to this study
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Using Data Mining Techniques to Support Breast Cancer Diagnosis. NEW CONTRIBUTIONS IN INFORMATION SYSTEMS AND TECHNOLOGIES 2015. [DOI: 10.1007/978-3-319-16486-1_68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Rosenkrantz AB, Mendiratta-Lala M, Bartholmai BJ, Ganeshan D, Abramson RG, Burton KR, Yu JPJ, Scalzetti EM, Yankeelov TE, Subramaniam RM, Lenchik L. Clinical utility of quantitative imaging. Acad Radiol 2015; 22:33-49. [PMID: 25442800 PMCID: PMC4259826 DOI: 10.1016/j.acra.2014.08.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 12/24/2022]
Abstract
Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI. The Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force has explored the clinical application of QI and summarizes its work in this review. We provide an overview of the clinical use of QI by discussing QI tools that are currently used in clinical practice, clinical applications of these tools, approaches to reporting of QI, and challenges to implementing QI. It is hoped that these insights will help radiologists recognize the tangible benefits of QI to their patients, their referring clinicians, and their own radiology practice.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Mishal Mendiratta-Lala
- Henry Ford Hospital, Abdominal and Cross-sectional Interventional Radiology, Detroit, Michigan
| | - Brian J Bartholmai
- Division of Radiology Informatics, Mayo Clinic in Rochester, Rochester, Minnesota
| | | | - Richard G Abramson
- Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kirsteen R Burton
- Department of Medical Imaging and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John-Paul J Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ernest M Scalzetti
- Department of Radiology, SUNY Upstate Medical University, Syracuse New York
| | - Thomas E Yankeelov
- Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
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Zhao YF, Jiao F, Liang HQ, Luo QC, Zhao LW. Primary malignant non-Hodgkin's lymphoma of the breast: A case report. Oncol Lett 2014; 8:2597-2600. [PMID: 25360172 PMCID: PMC4214428 DOI: 10.3892/ol.2014.2612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/16/2014] [Indexed: 11/05/2022] Open
Abstract
Primary malignant lymphoma of the breast (PLB) is a rare disease. Treatment options include surgical resection, systemic chemotherapy, radiation and immunotherapy. At present, the optimum treatment combination remains controversial. The present study reports the case of a 39-year-old female with a six month history of a painless mass in the left breast. The mass was excised following medical examination. A diagnosis of diffuse large B-cell lymphoma was determined as a result of histological and immunohistochemical profile analysis. Further examinations excluded metastatic disease. Thus, finally, PLB (diffuse large B-cell lymphoma type) was diagnosed. The patient was treated with adjuvant systemic chemotherapy and consolidated radiation and a positive response was observed. During the 10 months of follow-up, no evidence of disease recurrence was identified. At present, the patient is scheduled for regular follow-up appointments. As the prevalence of PLB is increasing, the details of this rare case may aid clinicians treating similar patients, and highlight the importance of this disease.
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Affiliation(s)
- Yun-Fei Zhao
- Department of Pathology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Feng Jiao
- Department of Oncology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai 201620, P.R. China
| | - Hai-Qiao Liang
- Department of Pathology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Qi-Chi Luo
- Department of Pathology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Lin-Wei Zhao
- Department of Radiology, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
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Miranda GHB, Felipe JC. Computer-aided diagnosis system based on fuzzy logic for breast cancer categorization. Comput Biol Med 2014; 64:334-46. [PMID: 25453323 DOI: 10.1016/j.compbiomed.2014.10.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/20/2014] [Accepted: 10/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fuzzy logic can help reduce the difficulties faced by computational systems to represent and simulate the reasoning and the style adopted by radiologists in the process of medical image analysis. The study described in this paper consists of a new method that applies fuzzy logic concepts to improve the representation of features related to image description in order to make it semantically more consistent. Specifically, we have developed a computer-aided diagnosis tool for automatic BI-RADS categorization of breast lesions. The user provides parameters such as contour, shape and density and the system gives a suggestion about the BI-RADS classification. METHODS Initially, values of malignancy were defined for each image descriptor, according to the BI-RADS standard. When analyzing contour, for example, our method considers the matching of features and linguistic variables. Next, we created the fuzzy inference system. The generation of membership functions was carried out by the Fuzzy Omega algorithm, which is based on the statistical analysis of the dataset. This algorithm maps the distribution of different classes in a set. RESULTS Images were analyzed by a group of physicians and the resulting evaluations were submitted to the Fuzzy Omega algorithm. The results were compared, achieving an accuracy of 76.67% for nodules and 83.34% for calcifications. CONCLUSIONS The fit of definitions and linguistic rules to numerical models provided by our method can lead to a tighter connection between the specialist and the computer system, yielding more effective and reliable results.
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Affiliation(s)
- Gisele Helena Barboni Miranda
- Department of Computing and Mathematics, Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo at Ribeirão Preto, Avenida Bandeirantes, 3900, Ribeirão Preto 14040-901, SP, Brazil.
| | - Joaquim Cezar Felipe
- Department of Computing and Mathematics, Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo at Ribeirão Preto, Avenida Bandeirantes, 3900, Ribeirão Preto 14040-901, SP, Brazil.
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Muller BG, van den Bos W, Brausi M, Cornud F, Gontero P, Kirkham A, Pinto PA, Polascik TJ, Rastinehad AR, de Reijke TM, de la Rosette JJ, Ukimura O, Villers A, Walz J, Wijkstra H, Marberger M. Role of multiparametric magnetic resonance imaging (MRI) in focal therapy for prostate cancer: a Delphi consensus project. BJU Int 2014; 114:698-707. [PMID: 24180365 DOI: 10.1111/bju.12548] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Berrend G. Muller
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | | | - Maurizio Brausi
- Department of Urology; EstenseS. Agostino Hospital; Modena Italy
| | | | - Paolo Gontero
- Department of Urology; Molinette University Hospital; Turin Italy
| | | | - Peter A. Pinto
- Department of Urology; National Cancer Institute; Bethesda MD
| | - Thomas J. Polascik
- Department of Surgery/Urology; Duke University Medical Center; Durham NC
| | | | - Theo M. de Reijke
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | | | - Osamu Ukimura
- Department of Urology; University of Southern California; Norris Cancer Center; Los Angeles CA USA
| | | | - Jochen Walz
- Department of Urology; Institut Paoli-Calmettes Cancer Center; Marseille France
| | - Hessel Wijkstra
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
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Shaheen E, De Keyzer F, Bosmans H, Dance DR, Young KC, Van Ongeval C. The simulation of 3D mass models in 2D digital mammography and breast tomosynthesis. Med Phys 2014; 41:081913. [PMID: 25086544 DOI: 10.1118/1.4890590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This work proposes a new method of building 3D breast mass models with different morphological shapes and describes the validation of the realism of their appearance after simulation into 2D digital mammograms and breast tomosynthesis images. METHODS Twenty-five contrast enhanced MRI breast lesions were collected and each mass was manually segmented in the three orthogonal views: sagittal, coronal, and transversal. The segmented models were combined, resampled to have isotropic voxel sizes, triangularly meshed, and scaled to different sizes. These masses were referred to as nonspiculated masses and were then used as nuclei onto which spicules were grown with an iterative branching algorithm forming a total of 30 spiculated masses. These 55 mass models were projected into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. The realism of the appearance of these mass models was assessed by five radiologists via receiver operating characteristic (ROC) analysis when compared to 54 real masses. All lesions were also given a breast imaging reporting and data system (BIRADS) score. The data sets of 2D mammography and tomosynthesis were read separately. The Kendall's coefficient of concordance was used for the interrater observer agreement assessment for the BIRADS scores per modality. Further paired analysis, using the Wilcoxon signed rank test, of the BIRADS assessment between 2D and tomosynthesis was separately performed for the real masses and for the simulated masses. RESULTS The area under the ROC curves, averaged over all observers, was 0.54 (95% confidence interval [0.50, 0.66]) for the 2D study, and 0.67 (95% confidence interval [0.55, 0.79]) for the tomosynthesis study. According to the BIRADS scores, the nonspiculated and the spiculated masses varied in their degrees of malignancy from normal (BIRADS 1) to highly suggestive for malignancy (BIRADS 5) indicating the required variety of shapes and margins of these models. The assessment of the BIRADS scores for all observers indicated good agreement based on Kendall's coefficient for both the 2D and the tomosynthesis evaluations. The paired analysis of the BIRADS scores between 2D and tomosynthesis for each observer revealed consistent behavior for the real and simulated masses. CONCLUSIONS A database of 3D mass models, with variety of shapes and margins, was validated for the realism of their appearance for 2D digital mammography and for breast tomosynthesis. This database is suitable for use in future observer performance studies whether in virtual clinical trials or in patient images with simulated lesions.
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Affiliation(s)
- Eman Shaheen
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Frederik De Keyzer
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hilde Bosmans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - David R Dance
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom and Department of Physics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Kenneth C Young
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom and Department of Physics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Evaluation of the PI-RADS scoring system for classifying mpMRI findings in men with suspicion of prostate cancer. BIOMED RESEARCH INTERNATIONAL 2013; 2013:252939. [PMID: 24396825 PMCID: PMC3876774 DOI: 10.1155/2013/252939] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/31/2013] [Accepted: 11/02/2013] [Indexed: 11/17/2022]
Abstract
Purpose. To evaluate the ESUR scoring system (PI-RADS) for multiparametric MRI of the prostate in clinical routine and to define a reliable way to generate an overall PI-RADS score. Methods. Retrospective analysis of all patients with a history of negative prebiopsies, who underwent 3 Tesla multiparametric MRI from October 2011 to April 2013 (n = 143): PI-RADS scores for each single modality were defined. To generate the overall PI-RADS score, an algorithm based approach summing up each single-modality score to a sum-score was compared to a more subjective approach, weighting the single modalities dependent on the radiologist's impression. Because of ongoing cancer suspicion 73 patients underwent targeted mpMRI-ultrasound image fusion rebiopsy. For this group thresholds for tumor incidences and malignancy were calculated. Results. 39 (53%) out of 73 targeted rebiopsies were cancer positive. The PI-RADS score correlated well with tumor incidence (AUC of 0.86, 95% CI 0.78 to 0.94) and malignancy (AUC 0.84, 95% CI 0.68 to 0.99). Regarding the sum-score a threshold of ≥10 turned out to be reliable for cancer detection (sensitivity 90%, specificity 62%) and for ≥13 for indicating higher malignancy (Gleason ≥4 + 3) (sensitivity 80%, specificity 86%). To generate the overall PI-RADS score, the use of an algorithm based approach was more reliable than that of the approach based on the radiologist's impression. Conclusion. The presented scoring system correlates well with tumor incidence and malignancy. To generate the overall PI-RADS score, it seems to be advisable to use an algorithm based instead of a subjective approach.
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Gallo Vallejo J, Mas Masats M, Vico Zúñiga I, Aibar Villán L. Mastopatía fibroquística. Aspectos controvertidos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Battaglia TA, Bak SM, Heeren T, Chen CA, Kalish R, Tringale S, Taylor JO, Lottero B, Egan AP, Thakrar N, Freund KM. Boston Patient Navigation Research Program: the impact of navigation on time to diagnostic resolution after abnormal cancer screening. Cancer Epidemiol Biomarkers Prev 2012; 21:1645-54. [PMID: 23045539 DOI: 10.1158/1055-9965.epi-12-0532] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is a need for controlled studies to assess the impact of patient navigation in vulnerable cancer populations. METHODS Boston Patient Navigation Research Program conducted a quasi-experimental patient navigation intervention across six federally qualified inner-city community health centers, three assigned to a breast cancer navigation intervention and three assigned to a cervical cancer navigation intervention; each group then served as the control for the other. Eligible women had an abnormal breast or cervical cancer screening test conducted at one of the participating health centers during a baseline (2004-2005) or intervention period (2007-2008). Kaplan-Meier survival curves and proportional hazards regression examined the effect of patient navigation on time to definitive diagnosis, adjusting for covariates, clustering by clinic and differences between the baseline and intervention period. RESULTS We enrolled 997 subjects in the baseline period and 3,041 subjects during the intervention period, of whom 1,497 were in the navigated arm, and 1,544 in the control arm. There was a significant decrease in time to diagnosis for subjects in the navigated group compared with controls among those with a cervical screening abnormality [aHR 1.46; 95% confidence interval (CI), 1.1-1.9]; and among those with a breast cancer screening abnormality that resolved after 60 days (aHR 1.40; 95% CI, 1.1-1.9), with no differences before 60 days. CONCLUSIONS This study documents a benefit of patient navigation on time to diagnosis among a racially/ethnically diverse inner city population. IMPACT Patient navigation may address cancer health disparities by reducing time to diagnosis following an abnormal cancer-screening event.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
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Kim MJ, Kim D, Jung W, Koo JS. Histological analysis of benign breast imaging reporting and data system categories 4c and 5 breast lesions in imaging study. Yonsei Med J 2012; 53:1203-10. [PMID: 23074123 PMCID: PMC3481383 DOI: 10.3349/ymj.2012.53.6.1203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective of this study was to analyze the histology of breast lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4c or 5 breast lesions during the imaging evaluation, but diagnosed as benign during the histological evaluation. MATERIALS AND METHODS We retrospectively reviewed 71 breast lesions categorized as BI-RADS 4c or 5 during imaging study, but diagnosed as benign upon histological evaluation. RESULTS Breast lesions were classified into six groups upon histological analysis: intraductal papilloma (18 cases), inflammatory group (15 cases), fibroepithelial tumor (14 cases), clustered microcalcification (10 cases), minimal histological alteration (10 cases), and adenosis (4 cases). Sclerosis and architectural complexity were associated with most of the biopsies that were morphologically similar to malignancy. CONCLUSION Among 71 cases categorized as 4c or 5 during the imaging study, but diagnosed as benign upon histological examination, intraductal papilloma was the most frequently identified histological lesion. These 71 cases exhibited histological characteristics of sclerosis and/or complex/complicated features that should be histologically differentiated from malignancy during evaluation.
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Affiliation(s)
- Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dokyung Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - WooHee Jung
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Conditional non-independence of radiographic image features and the derivation of post-test probabilities – A mammography BI-RADS example. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2012.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ling H, Liu ZB, Xu LH, Xu XL, Liu GY, Shao ZM. Malignant calcification is an important unfavorable prognostic factor in primary invasive breast cancer. Asia Pac J Clin Oncol 2012; 9:139-45. [PMID: 22897789 DOI: 10.1111/j.1743-7563.2012.01572.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2012] [Indexed: 11/29/2022]
Abstract
AIMS To explore the clinical characteristics and prognostic value of malignant calcification in operable breast cancer. METHODS A total of 721 patients with invasive ductal carcinoma were divided into two groups based on whether malignant calcifications were observed on mammograms. The association of calcification with pathological features and survival were evaluated. The relative importance of each of the potential prognostic variables was tested using a Cox regression analysis. RESULTS Compared with tumors without calcification, those with calcification had a larger tumor size, more lymph node involvement, lower estrogen and progesterone receptor expression and higher human epithelial growth factor receptor 2 expression. The 8-year relapse-free survival was lower for patients with calcifications than for those without (77.5 vs 89.2%, P < 0.01). The 8-year overall survival for patients with calcifications was 82.2% compared with 91.9% for those without (P < 0.01). In multivariate analysis, node status, existence of calcification and tumor size were demonstrated to have a prognostic value for relapse-free survival. The node status, existence of calcifications and estrogen receptor status were also prognostic factors for overall survival. CONCLUSION Mammographic calcification is a poor prognostic factor for patients with invasive ductal carcinoma. Its prognostic value is second only to axillary node status and greater than the other factors evaluated. Thus, breast cancers with calcifications should be regarded as high risk when determining adjuvant treatment.
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Affiliation(s)
- Hong Ling
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Morais-Socorro M, Cavalcanti MA, Martins R, Neto Francisco P, Rezende A, Azevedo G, Almeida M. Safety and efficacy of tibolone and menopausal transition: a randomized, double-blind placebo-controlled trial. Gynecol Endocrinol 2012; 28:483-7. [PMID: 22132809 DOI: 10.3109/09513590.2011.634937] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy, safety and tolerability of Tibolone use during the menopausal transition (MT). METHODS Sixty-five healthy women aged 40-55 years (48.5 ± 3.5 years) were recruited for a randomized, double-blind controlled trial. Thirty participants were recruited to receive oral Tibolone 2.5 mg/day - Tibolone Group (TG), and 35 participants were assigned to the Placebo Group (PG), which received one capsule of lactose/day. Both groups were treated for 12 consecutive weeks. The Blatt-Kupperman Menopausal Index (KMI) and the Greene Climacteric Scale (GCS) were used. The glycaemic and lipid profiles, biochemical measures of hepatic function and endometrial thickness were measured for safety. A daily registry of complaints related to the treatment was maintained, and anthropometric measures were obtained to assess tolerability. RESULTS A total of 57 women completed the study. After 12 weeks of Tibolone use, the total score and percentage of the KMI and GCS were significantly decreased compared to baseline, which reflected the efficacy of the treatment of climacteric symptoms. The improvement in blood biochemistry, endometrial atrophy and maintenance of the anthropometrical measures reflected the safety of Tibolone use. The absence of serious side effects demonstrated good tolerability for Tibolone use. CONCLUSIONS The results showed good efficacy, tolerability and safety of Tibolone use during the MT.
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Affiliation(s)
- Maria Morais-Socorro
- Maternity Januário Cicco, Federal University of Rio Grande do Norte, School, Natal, Brazil.
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Youk JH, Son EJ, Kim JA, Moon HJ, Kim MJ, Choi CH, Kim EK. Scoring System Based on BI-RADS Lexicon to Predict Probability of Malignancy in Suspicious Microcalcifications. Ann Surg Oncol 2011; 19:1491-8. [DOI: 10.1245/s10434-011-2167-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Indexed: 11/18/2022]
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Functional SNP in the microRNA-367 binding site in the 3'UTR of the calcium channel ryanodine receptor gene 3 (RYR3) affects breast cancer risk and calcification. Proc Natl Acad Sci U S A 2011; 108:13653-8. [PMID: 21810988 DOI: 10.1073/pnas.1103360108] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We have evaluated and provided evidence that the ryanodine receptor 3 gene (RYR3), which encodes a large protein that forms a calcium channel, is important for the growth, morphology, and migration of breast cancer cells. A putative binding site for microRNA-367 (miR-367) exists in the 3'UTR of RYR3, and a genetic variant, rs1044129 A→G, is present in this binding region. We confirmed that miR-367 regulates the expression of a reporter gene driven by the RYR3 3'UTR and that the regulation was affected by the RYR3 genotype. A thermodynamic model based on base pairing and the secondary structure of the RYR3 mRNA and miR-367 miRNA showed that miR-367 had a higher binding affinity for the A genotype than for the G genotype. The rs1044129 SNP was genotyped in 1,532 breast cancer cases and 1,600 healthy Chinese women. The results showed that compared with the AA genotype, G was a risk genotype for breast cancer development and was also associated with breast cancer calcification and poor survival. Thus, rs1044129 is a unique SNP that resides in a miRNA-gene regulatory loop that affects breast cancer risk, calcification, and survival.
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