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Patel BK, Carnahan MB, Northfelt D, Anderson K, Mazza GL, Pizzitola VJ, Giurescu ME, Lorans R, Eversman WG, Sharpe RE, Harper LK, Apsey H, Cronin P, Kling J, Ernst B, Palmieri J, Fraker J, Mina L, Batalini F, Pockaj B. Prospective Study of Supplemental Screening With Contrast-Enhanced Mammography in Women With Elevated Risk of Breast Cancer: Results of the Prevalence Round. J Clin Oncol 2024:JCO2202819. [PMID: 39058970 DOI: 10.1200/jco.22.02819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/14/2024] [Accepted: 05/01/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE Contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) have shown similar diagnostic performance in detection of breast cancer. Limited CEM data are available for high-risk breast cancer screening. The purpose of the study was to prospectively investigate the efficacy of supplemental screening CEM in elevated risk patients. MATERIALS AND METHODS A prospective, single-institution, institutional review board-approved observational study was conducted in asymptomatic elevated risk women age 35 years or older who had a negative conventional two-dimensional digital breast tomosynthesis screening mammography (MG) and no additional supplemental screening within the prior 12 months. RESULTS Four hundred sixty women were enrolled from February 2019 to April 2021. The median age was 56.8 (range, 35.0-79.2) years; 408 of 460 (88.7%) were mammographically dense. Biopsy revealed benign changes in 22 women (22/37, 59%), high-risk lesions in four women (4/37, 11%), and breast cancer in 11 women (11/37, 30%). Fourteen cancers (10 invasive, tumor size range 4-15 mm, median 9 mm) were diagnosed in 11 women. The overall supplemental cancer detection rate was 23.9 per 1,000 patients, 95% CI (12.0 to 42.4). All cancers were grade 1 or 2, ER+ ERBB2-, and node negative. CEM imaging screening offered high specificity (0.875 [95% CI, 0.844 to 0.906]), high NPV (0.998 [95% CI, 0.993 to 1.000), moderate PPV1 (0.164 [95% CI, 0.076 to 0.253), moderate PPV3 (0.275 [95% CI, 0.137 to 0.413]), and high sensitivity (0.917 [95% CI, 0.760 to 1.000]). At least 1 year of imaging follow-up was available on all patients, and one interval cancer was detected on breast MRI 4 months after negative screening CEM. CONCLUSION A pilot trial demonstrates a supplemental cancer detection rate of 23.9 per 1,000 in women at an elevated risk for breast cancer. Larger, multi-institutional, multiyear CEM trials in patients at elevated risk are needed for validation.
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Affiliation(s)
- Bhavika K Patel
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Donald Northfelt
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Karen Anderson
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Roxanne Lorans
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Laura K Harper
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Heidi Apsey
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Patricia Cronin
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Juliana Kling
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Brenda Ernst
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Jessica Fraker
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Lida Mina
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Felipe Batalini
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Barbara Pockaj
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
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Qian N, Jiang W, Wu X, Zhang N, Yu H, Guo Y. Lesion attention guided neural network for contrast-enhanced mammography-based biomarker status prediction in breast cancer. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108194. [PMID: 38678959 DOI: 10.1016/j.cmpb.2024.108194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/13/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Accurate identification of molecular biomarker statuses is crucial in cancer diagnosis, treatment, and prognosis. Studies have demonstrated that medical images could be utilized for non-invasive prediction of biomarker statues. The biomarker status-associated features extracted from medical images are essential in developing medical image-based non-invasive prediction models. Contrast-enhanced mammography (CEM) is a promising imaging technique for breast cancer diagnosis. This study aims to develop a neural network-based method to extract biomarker-related image features from CEM images and evaluate the potential of CEM in non-invasive biomarker status prediction. METHODS An end-to-end learning convolutional neural network with the whole breast images as inputs was proposed to extract CEM features for biomarker status prediction in breast cancer. The network focused on lesion regions and flexibly extracted image features from lesion and peri‑tumor regions by employing supervised learning with a smooth L1-based consistency constraint. An image-level weakly supervised segmentation network based on Vision Transformer with cross attention to contrast images of breasts with lesions against the contralateral breast images was developed for automatic lesion segmentation. Finally, prediction models were developed following further selection of significant features and the implementation of random forest-based classification. Results were reported using the area under the curve (AUC), accuracy, sensitivity, and specificity. RESULTS A dataset from 1203 breast cancer patients was utilized to develop and evaluate the proposed method. Compared to the method without lesion attention and with only lesion regions as inputs, the proposed method performed better at biomarker status prediction. Specifically, it achieved an AUC of 0.71 (95 % confidence interval [CI]: 0.65, 0.77) for Ki-67 and 0.73 (95 % CI: 0.65, 0.80) for human epidermal growth factor receptor 2 (HER2). CONCLUSIONS A lesion attention-guided neural network was proposed in this work to extract CEM image features for biomarker status prediction in breast cancer. The promising results demonstrated the potential of CEM in non-invasively predicting the biomarker statuses in breast cancer.
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Affiliation(s)
- Nini Qian
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China
| | - Wei Jiang
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China; Department of Radiotherapy, Yantai Yuhuangding Hospital, Shandong 264000, China
| | - Xiaoqian Wu
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Ning Zhang
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China
| | - Hui Yu
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China
| | - Yu Guo
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China.
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3
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Petrillo A, Fusco R, Petrosino T, Vallone P, Granata V, Rubulotta MR, Pariante P, Raiano N, Scognamiglio G, Fanizzi A, Massafra R, Lafranceschina M, La Forgia D, Greco L, Ferranti FR, De Soccio V, Vidiri A, Botta F, Dominelli V, Cassano E, Sorgente E, Pecori B, Cerciello V, Boldrini L. A multicentric study of radiomics and artificial intelligence analysis on contrast-enhanced mammography to identify different histotypes of breast cancer. LA RADIOLOGIA MEDICA 2024; 129:864-878. [PMID: 38755477 DOI: 10.1007/s11547-024-01817-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To evaluate the performance of radiomic analysis on contrast-enhanced mammography images to identify different histotypes of breast cancer mainly in order to predict grading, to identify hormone receptors, to discriminate human epidermal growth factor receptor 2 (HER2) and to identify luminal histotype of the breast cancer. METHODS From four Italian centers were recruited 180 malignant lesions and 68 benign lesions. However, only the malignant lesions were considered for the analysis. All patients underwent contrast-enhanced mammography in cranium caudal (CC) and medium lateral oblique (MLO) view. Considering histological findings as the ground truth, four outcomes were considered: (1) G1 + G2 vs. G3; (2) HER2 + vs. HER2 - ; (3) HR + vs. HR - ; and (4) non-luminal vs. luminal A or HR + /HER2- and luminal B or HR + /HER2 + . For multivariate analysis feature selection, balancing techniques and patter recognition approaches were considered. RESULTS The univariate findings showed that the diagnostic performance is low for each outcome, while the results of the multivariate analysis showed that better performances can be obtained. In the HER2 + detection, the best performance (73% of accuracy and AUC = 0.77) was obtained using a linear regression model (LRM) with 12 features extracted by MLO view. In the HR + detection, the best performance (77% of accuracy and AUC = 0.80) was obtained using a LRM with 14 features extracted by MLO view. In grading classification, the best performance was obtained by a decision tree trained with three predictors extracted by MLO view reaching an accuracy of 82% on validation set. In the luminal versus non-luminal histotype classification, the best performance was obtained by a bagged tree trained with 15 predictors extracted by CC view reaching an accuracy of 94% on validation set. CONCLUSIONS The results suggest that radiomics analysis can be effectively applied to design a tool to support physician decision making in breast cancer classification. In particular, the classification of luminal versus non-luminal histotypes can be performed with high accuracy.
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Affiliation(s)
- Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy.
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013, Naples, Italy
| | - Teresa Petrosino
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Paolo Vallone
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Maria Rosaria Rubulotta
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Paolo Pariante
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Nicola Raiano
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Giosuè Scognamiglio
- Pathology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Annarita Fanizzi
- Direzione Scientifica, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Raffaella Massafra
- SSD Fisica Sanitaria, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Miria Lafranceschina
- Struttura Semplice Dipartimentale Di Radiodiagnostica Senologica, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale Di Radiodiagnostica Senologica, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Laura Greco
- Radiology and Diagnostic Imaging, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Romana Ferranti
- Radiology and Diagnostic Imaging, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria De Soccio
- Radiology and Diagnostic Imaging, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Botta
- Breast Imaging Division, IEO Istituto Europeo Di Oncologia, 20141, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO Istituto Europeo Di Oncologia, 20141, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO Istituto Europeo Di Oncologia, 20141, Milan, Italy
| | - Eugenio Sorgente
- Radiation Protection and Innovative Technology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Biagio Pecori
- Radiation Protection and Innovative Technology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Vincenzo Cerciello
- Medical Physics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Luca Boldrini
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
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Giannotti E, Van Nijnatten TJA, Chen Y, Bicchierai G, Nori J, De Benedetto D, Lalji U, Lee AHS, James J. The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast. Clin Radiol 2024; 79:e799-e806. [PMID: 38383254 DOI: 10.1016/j.crad.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
AIM To assess the performance of contrast-enhanced mammography (CEM) in the preoperative staging of invasive lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS The present study was a multicentre, multivendor, multinational retrospective study of women with a histological diagnosis of ILC who had undergone CEM from December 2013 to December 2021. Index lesion size and multifocality were recorded for two-dimensional (2D) mammography, CEM, and when available magnetic resonance imaging (MRI). Comparison with histological data was undertaken for women treated by primary surgical excision. Pearson correlation coefficients and Bland-Altman's analysis of agreement were used to assess differences with a significance level of 0.05. RESULTS One hundred and fifteen ILC lesions were included, 46 (40%) presented symptomatically and 69 were screening detected. CEM demonstrated superior sensitivity when compared to standard mammography. The correlation between the histological size measured on the surgical excision specimen size was greater than with standard mammography (r=0.626 and 0.295 respectively, p=0.001), with 19% of lobular carcinomas not visible without a contrast agent. The sensitivity of CEM for multifocal disease was greater than standard mammography (70% and 20% respectively, p<0.0001). CEM overestimated tumour size by an average of 1.5 times, with the size difference increasing for larger tumour. When MRI was performed (n=22), tumour size was also overestimated by an average of 1.3 times. The degree of size overestimation was similar for both techniques, with the tumour size on CEM being on average 0.5 cm larger than MRI. CONCLUSION CEM is a useful tool for the local staging of lobular carcinomas and could be an alternative to breast MRI.
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Affiliation(s)
- E Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK; Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK.
| | - T J A Van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Y Chen
- University of Nottingham, School of Medicine, Division of Cancer and Stem Cells, City Hospital Campus, Nottingham, UK
| | - G Bicchierai
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - J Nori
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - D De Benedetto
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - U Lalji
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A H S Lee
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - J James
- Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK
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McDonald ES, Scheel JR, Lewin AA, Weinstein SP, Dodelzon K, Dogan BE, Fitzpatrick A, Kuzmiak CM, Newell MS, Paulis LV, Pilewskie M, Salkowski LR, Silva HC, Sharpe RE, Specht JM, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024; 21:S168-S202. [PMID: 38823943 DOI: 10.1016/j.jacr.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Elizabeth S McDonald
- Research Author, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Scheel
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Basak E Dogan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Fitzpatrick
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | | | - Melissa Pilewskie
- University of Michigan, Ann Arbor, Michigan; Society of Surgical Oncology
| | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - H Colleen Silva
- The University of Texas Medical Branch, Galveston, Texas; American College of Surgeons
| | | | - Jennifer M Specht
- University of Washington, Seattle, Washington; American Society of Clinical Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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Ancona A, Telegrafo M, Fella RR, Iamele D, Cantore S, Moschetta M. CEM immediately after contrast-enhanced CT: a one-step staging of breast cancer. Eur Radiol Exp 2024; 8:32. [PMID: 38556593 PMCID: PMC10982147 DOI: 10.1186/s41747-024-00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is a promising technique. We evaluated the diagnostic potential of CEM performed immediately after contrast-enhanced computed tomography (CE-CT). METHODS Fifty patients with breast cancer underwent first CE-CT and then CEM without additional contrast material injection. Two independent radiologists evaluated CEM images. The sensitivity of CEM for detecting index and additional malignant lesions was compared with that of mammography/ultrasonography by the McNemar test, using histopathology as a reference standard. Interobserver agreement for detection of malignant lesions, for classifying index tumors, and for evaluating index tumor size and extent was assessed using Cohen κ. Pearson correlation was used for correlating index tumor size/extent at CEM or mammography/ultrasonography with histopathology. RESULTS Of the 50 patients, 30 (60%) had unifocal disease while 20 (40%) had multicentric or multifocal disease; 5 of 20 patients with multicentric disease (25%) had bilateral involvement, for a total of 78 malignant lesions, including 72 (92%) invasive ductal and 6 (8%) invasive lobular carcinomas. Sensitivity was 63/78 (81%, 95% confidence interval 70.27-88.82) for unenhanced breast imaging and 78/78 (100%, 95.38-100) for CEM (p < 0.001). The interobserver agreement for overall detection of malignant lesions, for classifying index tumor, and for evaluating index tumor size/extent were 0.94, 0.95, and 0.86 κ, respectively. For index tumor size/extent, correlation coefficients as compared with histological specimens were 0.50 for mammography/ultrasonography and 0.75 for CEM (p ≤ 0.010). CONCLUSIONS CEM acquired immediately after CE-CT without injection of additional contrast material showed a good performance for local staging of breast cancer. RELEVANCE STATEMENT When the CEM suite is near to the CE-CT acquisition room, CEM acquired immediately after, without injection of additional contrast material, could represent a way for local staging of breast cancer to be explored in larger prospective studies. KEY POINTS • CEM represents a new accurate tool in the field of breast imaging. • An intravenous injection of iodine-based contrast material is required for breast gland evaluation. • CEM after CE-CT could provide a one-stop tool for breast cancer staging.
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Affiliation(s)
- Antonietta Ancona
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Michele Telegrafo
- Breast Care Unit, University Hospital Consortium Policlinico of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Rita Roberta Fella
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Donato Iamele
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Sebastiano Cantore
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Marco Moschetta
- DIM, Interdisciplinary Department of Medicine, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, 70124, Italy.
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7
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Sammarra M, Piccolo CL, Sarli M, Stefanucci R, Tommasiello M, Orsaria P, Altomare V, Beomonte Zobel B. Contrast-Enhanced Mammography-Guided Biopsy: Preliminary Results of a Single-Center Retrospective Experience. J Clin Med 2024; 13:933. [PMID: 38398247 PMCID: PMC10889410 DOI: 10.3390/jcm13040933] [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: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Background: CEM-guided breast biopsy is an advanced diagnostic procedure that takes advantage of the ability of CEM to enhance suspicious breast lesions. The aim pf this paper is to describe a single-center retrospective experience on CEM-guided breast biopsy in terms of procedural features and histological outcomes. Methods: 69 patients underwent the procedure. Patient age, breast density, presentation, dimensions, and lesion target enhancement were recorded. All the biopsy procedures were performed using a 7- or 10-gauge (G) vacuum-assisted biopsy needle. The procedural approach (horizontal or vertical) and the decubitus of the patient (lateral or in a sitting position) were noted. Results: A total of 69 patients underwent a CEM-guided biopsy. Suspicious lesions presented as mass enhancement in 35% of cases and non-mass enhancement in 65% of cases. The median size of the target lesions was 20 mm. The median procedural time for each biopsy was 10 ± 4 min. The patients were placed in a lateral decubitus position in 52% of cases and seated in 48% of cases. The most common approach was horizontal (57%). The mean AGD was 14.8 mGy. At histology, cancer detection rate was 28% (20/71). Conclusions: CEM-guided biopsy was feasible, with high procedure success rates and high tolerance by the patients.
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Affiliation(s)
- Matteo Sammarra
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Claudia Lucia Piccolo
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Marina Sarli
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rita Stefanucci
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Manuela Tommasiello
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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8
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Corines MJ, Sogani J, Hogan MP, Mango VL, Bryce Y. The Role of Contrast-Enhanced Mammography After Cryoablation of Breast Cancer. AJR Am J Roentgenol 2024; 222:e2330250. [PMID: 38019473 DOI: 10.2214/ajr.23.30250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Image-guided cryoablation is an emerging therapeutic technique for the treatment of breast cancer and is a treatment strategy that is an effective alternate to surgery in select patients. Tumor features impacting the efficacy of cryoablation include size, location in relation to skin, and histology (e.g., extent of intraductal component), underscoring the importance of imaging for staging and workup in this patient population. Contrast-enhanced mammography (CEM) utilization is increasing in both the screening and diagnostic settings and may be useful for follow-up imaging after breast cancer cryoablation, given its high sensitivity for cancer detection and its advantages in terms of PPV, time, cost, eligibility, and accessibility compared with contrast-enhanced MRI. This Clinical Perspective describes the novel use of CEM after breast cancer cryoablation, highlighting the advantages and disadvantages of CEM compared with alternate imaging modalities, expected benign postablation CEM findings, and CEM findings suggestive of residual or recurrent tumor.
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Affiliation(s)
- Marina J Corines
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Julie Sogani
- Department of Radiology, Englewood Hospital and Medical Center, Englewood, NJ
| | - Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Victoria L Mango
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Yolanda Bryce
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Greenwood HI, Dodelzon K. Screening in Women With BRCA Mutations Revisited. JOURNAL OF BREAST IMAGING 2024; 6:4-13. [PMID: 38166173 DOI: 10.1093/jbi/wbad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 01/04/2024]
Abstract
Patients with BRCA1 or BRCA2 gene mutations are at high risk for the development of breast cancer. This article reviews the current evidence for breast cancer screening of patients with BRCA1 or BRCA2 pathogenic gene mutations if they have not undergone prophylactic mastectomy. It will review the current evidence-based imaging recommendations for different modalities and ages of screening initiation in screening this patient population at high risk. Special considerations in transgender BRCA1 and BRCA2 mutation carriers are also discussed.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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10
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Sunen I, Isabel Garcia Barrado A, Cruz Ciria S, Garcia Maroto J, Gros Bañeres B, Garcia Mur C. Is contrast-enhanced mammography (CEM) an alternative to MRI in assessing the response to primary systemic therapy of breast cancer? Eur J Radiol 2024; 170:111270. [PMID: 38141263 DOI: 10.1016/j.ejrad.2023.111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE To evaluate the accuracy of contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) in the assessing radiological response to primary systemic therapy (PST). METHOD Prospective study between February 2021 and October 2022. Women with breast cancer and indication of PST were enrolled. CEM and MRI were performed before and after PST, and the findings, including size and radiological response pattern, were compared with the size of the residual lesion measured in surgical specimens and its Miller-Payne classification (considered the gold standard). Two of four independent radiologists, with 2 years of CEM experience and 10 years of MRI experience, reviewed the images while being blinded to the results of the other technique. The agreement between measurements was evaluated using the Pearson correlation coefficient (r) and Lin's coefficient. RESULTS Forty-eight women with breast cancer who required PST were enrolled in the study, with a mean age of 57.21 ± 10.14 years. A total of thirty-three participants (68.75 %) completed the study. The correlation between CEM and MRI measurements was high before PST (r: 0.97), and local staging was identical for 45 out of 48 patients. MRI demonstrated better accuracy in predicting residual tumor size than CEM, with Lin's coefficient 0.91 and 0.73, respectively. However, no significant differences were observed in predicting response to therapy. Both methods tended to overestimate the size and degree of response in our study, with mean overestimations of 2.87 mm in CEM and 0.51 mm in MRI. CONCLUSION CEM was found to be as accurate as MRI in predicting response to PST, indicating its potential as an alternative imaging technique, but further research is necessary.
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Affiliation(s)
- Ines Sunen
- Department of Radiology, Nuestra Señora de Gracia Hospital, Zaragoza, Spain.
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11
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Thanh Ha Nguyen M, Varma N, Lan Cheong Wah D, Chew R, Botha T, Kouloyan-Ilic S, Paiva J. Performance of contrast-enhanced mammography for detecting multifocal and multicentric breast cancer and evaluating tumour size, and implications for surgical management: Early experience in a tertiary centre. J Med Imaging Radiat Oncol 2023. [PMID: 38146085 DOI: 10.1111/1754-9485.13616] [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: 06/05/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION To compare diagnostic accuracy of contrast-enhanced mammography (CEM) with standard 2D digital mammography (equivalent to low-energy image; LEM) for detection of multifocal and multicentric breast cancer and evaluation of tumour size and disease extent for preoperative planning. METHODS Biopsy proven breast cancer patients who underwent CEM preoperatively between January 2021 and January 2023 were included in this study. CEM and LEM images were independently reviewed by at least two blinded readers. Lesion location, number, size (maximal diameter) and extension across the midline and/or nipple invasion were recorded. Tumour number and size estimated on imaging were compared with final operative histology, which served as the gold standard. RESULTS Forty-nine patients (48 females and 1 male) and 50 cases (one patient had bilateral breast lesions) were included in the analysis. Median patient age was 60 (IQR 51, 69). CEM had significantly higher lesion detection rate compared with LEM, with sensitivities of 78% for LEM and 92% for CEM for the index tumour and 15% for LEM and 100% for CEM for multicentric and multifocal cancer. We found no statistically significant difference in median tumour size measurements on CEM and final surgical specimen (P value = 0.97); however, a significant difference was identified in the tumour size measured on LEM and surgical specimen (P value < 0.001). CONCLUSION CEM is superior to standard 2D digital mammography for detection of multifocal and multicentric breast cancer and is a reliable and more accurate method for estimating tumour size.
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Affiliation(s)
- Margaret Thanh Ha Nguyen
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Nisha Varma
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - David Lan Cheong Wah
- Department of Breast Surgery, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Renny Chew
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Tanita Botha
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Susan Kouloyan-Ilic
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Joseph Paiva
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
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12
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Fischer U, Diekmann F, Helbich T, Preibsch H, Püsken M, Wenkel E, Wienbeck S, Fallenberg EM. [Use of contrast-enhanced mammography for diagnosis of breast cancer]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:916-924. [PMID: 37889284 PMCID: PMC10692004 DOI: 10.1007/s00117-023-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is an imaging method that is able to improve visualization of intramammary tumors after peripheral venous administration of an iodine-containing contrast medium (ICM). OBJECTIVES AND METHODS The current significance of CEM is discussed. RESULTS Studies were able to show an advantage of CEM in the diagnosis of breast cancer compared to mammography, especially for women with dense breasts. Indications for CEM currently depend on the availability of magnetic resonance imaging (MRI). If MRI is available, CEM is indicated in those cases when MRI cannot be performed. Use of CEM for breast cancer screening is currently viewed critically. This view can change when results and updated assessments of large CEM studies in Europe and USA become available. Patients must be informed about the use of an ICM. As ICM administration for CEM is carried out in a similar manner to established imaging methods, the authors expect the use of ICM for CEM to be unproblematic as long as general contraindications are adhered to. CONCLUSIONS In the future, CEM could have greater importance for the diagnosis of breast cancer, as this imaging method has diagnostic advantages compared to conventional mammography. A great advantage of CEM is its availability. For those who use breast MRI, CEM is helpful when MRI is not feasible due to contraindications or other reasons.
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Affiliation(s)
- Uwe Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen, Deutschland.
| | - Felix Diekmann
- Institut für Radiologische Diagnostik, Krankenhaus St. Joseph-Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Thomas Helbich
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Pädiatrische Radiologie, Medizinische Universität Wien/AKH WIEN, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Heike Preibsch
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Michael Püsken
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Evelyn Wenkel
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Radiologie München, München, Deutschland
| | - Susanne Wienbeck
- Radiologie Schwarzer Bär MVZ, Schwarzer Bär 8, 30449, Hannover, Deutschland
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Eva Maria Fallenberg
- Institut für diagnostische und interventionelle Radiologie, School of Medicine & Klinikum rechts der Isar Technische Universität München (TUM), Ismaninger Str. 22, 81675, München, Deutschland
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13
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Li N, Gong W, Xie Y, Sheng L. Correlation between the CEM imaging characteristics and different molecular subtypes of breast cancer. Breast 2023; 72:103595. [PMID: 37925875 PMCID: PMC10661457 DOI: 10.1016/j.breast.2023.103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/09/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE To investigate the correlation between the contrast-enhanced mammography (CEM) imaging characteristics and different molecular subtypes of breast cancer (BC). METHODS We retrospectively included 313 eligible female patients who underwent CEM examination and surgery in our hospital from July 2017 to July 2021. Their lesions were confirmed on histopathological examination and immunohistochemical analysis. BC was divided into luminal A, luminal B, HER2-enriched, and triple-negative BC (TNBC) subtypes according to immunohistochemical markers. Nine features were extracted from CEM images, including tumor shape, margins, spiculated mass, lobulated mass, malignant calcification, lesion conspicuity, internal enhancement pattern, multifocal mass, and swollen axillary lymph nodes. Statistical analysis was performed using SPSS 25.0. Univariate analysis and binomial regression were used to analyze the correlation between CEM imaging features and BC molecular subtypes. RESULTS There were 184 (58.8 %) Luminal A, 44 (14.1 %) Luminal B, 47 (15.0 %) HER-2-enriched and 38 (12.1 %) TNBC, respectively. Molecular subtypes were significantly related to the tumor shape, margins, spiculated mass, internal enhancement pattern, malignant calcification and swollen axillary lymph nodes. Spiculated and calcified tumors were associated with Luminal subtypes, especially Luminal B (P < 0.05). Irregular tumor shape and malignant calcification were associated with HER-2-enriched subtype (P < 0.05). Oval or round tumor shape, rim enhancement, and swollen axillary lymph nodes were associated with TNBC (P < 0.05). CONCLUSION CEM imaging features could distinguish BC molecular subtypes. In particular, TNBC showed oval or round tumor shape, rim enhancement, and swollen axillary lymph nodes, providing insights into the diagnosis and prognosis of TNBC.
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Affiliation(s)
- Na Li
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, 272000, China.
| | - Weiyun Gong
- Clinic Imaging Center, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, 271000, China
| | - Yuanzhong Xie
- Clinic Imaging Center, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, 271000, China
| | - Lei Sheng
- Clinic Imaging Center, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, 271000, China.
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14
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Kaiyin M, Lingling T, Leilei T, Wenjia L, Bin J. Head-to-head comparison of contrast-enhanced mammography and contrast-enhanced MRI for assessing pathological complete response to neoadjuvant therapy in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat 2023; 202:1-9. [PMID: 37615793 DOI: 10.1007/s10549-023-07034-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Breast cancer patients receiving neoadjuvant therapy (NAT) are in need of a more patient-friendly imaging modality such as contrast-enhanced mammography (CEM) for monitoring therapy response. The purpose of this study was to conduct a meta-analysis to compare the diagnostic performances of CEM and contrast-enhanced magnetic resonance imaging (CE-MRI) for assessing pathological complete response (pCR) in these patients. METHODS The PubMed, Embase, and Cochrane Library databases were searched through March 2023 to identify studies reporting a head-to-head comparison of CEM and CE-MRI in detecting pCR in breast cancer patients receiving NAT. Pooled diagnostic performance was calculated using a bivariate random-effects model, and an AUC was derived for each test from hierarchic summary ROC analysis. RESULTS Six studies with 328 patients were included. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 93% (95% CI 84-97%), 68% (95% CI 60-76%), and 29.29 (95% CI 11.41-75.18) for CEM versus 84% (95% CI 62-95%), 80% (95% CI 71-87%), and 21.39 (95% CI 5.94-77.13) for CE-MRI. The AUC was 0.85 (95% CI 0.82-0.88) for CEM and 0.85 (95% CI 0.82-0.88) for CE-MRI. CONCLUSION This meta-analysis of head-to-head comparison studies showed that CEM provides an equivalent diagnostic accuracy to CE-MRI in identification of pCR in breast cancer patients receiving NAT. The results support the increasing use of CEM in this setting and would encourage future studies to validate CEM as a suitable replacement for MRI.
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Affiliation(s)
- Min Kaiyin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Tong Lingling
- Department of Gynecology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tang Leilei
- Department of Imaging, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Li Wenjia
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
| | - Ji Bin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
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15
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Cockmartin L, Bosmans H, Marshall NW. Investigation of test methods for QC in dual-energy based contrast-enhanced digital mammography systems: I. Iodine signal testing. Phys Med Biol 2023; 68:215017. [PMID: 37820689 DOI: 10.1088/1361-6560/ad027d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
The technique of dual-energy contrast enhanced mammography (CEM) visualizes iodine uptake in cancerous breast lesions following an intravenous injection of a contrast medium. The CEM image is generated by recombining two images acquired in rapid succession: a low energy image, with a mean energy below the iodine K-edge, and a higher energy image. The first part of this study examines the use of both commercially available and custom made phantoms to investigate iodine imaging under different imaging conditions, with the focus on quality control (QC) testing. Four CEM equipped systems were included in the study, with units from Fujifilm, GE Healthcare, Hologic and Siemens-Healthineers. The CEM parameters assessed in part I were: (1) image signal as a function of iodine concentration, measured in breast tissue simulating backgrounds of varying thickness and adipose/glandular compositions; (2) normal breast texture cancellation in homogeneous and structured backgrounds; (3) visibility of iodinated structures. For all four systems, a linear response to iodine concentration was found but the degree to which this was independent of background composition differed between the systems. Good cancellation of the glandular tissue inserts was found on all the units. Visibility scores of iodinated targets were similar between the four systems. Specialized phantoms are needed to fully evaluate important CEM performance markers, such as system response to iodine concentration and the ability of the system to cancel background texture. An extensive evaluation of the iodine signal imaging performance is recommended at the Commissioning stage for a new CEM device.
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Affiliation(s)
- L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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16
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Saleh GA, Batouty NM, Gamal A, Elnakib A, Hamdy O, Sharafeldeen A, Mahmoud A, Ghazal M, Yousaf J, Alhalabi M, AbouEleneen A, Tolba AE, Elmougy S, Contractor S, El-Baz A. Impact of Imaging Biomarkers and AI on Breast Cancer Management: A Brief Review. Cancers (Basel) 2023; 15:5216. [PMID: 37958390 PMCID: PMC10650187 DOI: 10.3390/cancers15215216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.
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Affiliation(s)
- Gehad A. Saleh
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Nihal M. Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Abdelrahman Gamal
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elnakib
- Electrical and Computer Engineering Department, School of Engineering, Penn State Erie, The Behrend College, Erie, PA 16563, USA;
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Centre, Mansoura University, Mansoura 35516, Egypt;
| | - Ahmed Sharafeldeen
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Jawad Yousaf
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Marah Alhalabi
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Amal AbouEleneen
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elsaid Tolba
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
- The Higher Institute of Engineering and Automotive Technology and Energy, New Heliopolis, Cairo 11829, Egypt
| | - Samir Elmougy
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
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17
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Taylor DB, Hobbs MM, Ronald MM, Burrows S, Ives A, Parizel PM, Saunders CM. Interpreting contrast imaging to plan breast surgery. ANZ J Surg 2023; 93:2197-2202. [PMID: 37438677 DOI: 10.1111/ans.18583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Contrast enhanced mammography (CEM) and magnetic resonance imaging (MRI) are more accurate than conventional imaging (CI) for breast cancer staging. How adding CEM and MRI to CI might change the surgical plan is understudied. METHODS Surgical plans (breast conserving surgery (BCS), wider BCS, BCS with diagnostic excision (>1BCS), mastectomy) were devised by mock-MDT (radiologist, surgeon and pathology reports) according to disease extent on CI, CI + CEM and CI + MRI. Differences in the mock-MDT's surgical plans following the addition of CEM or MRI were investigated. Using pre-defined criteria, the appropriateness of the modified plans was assessed by comparing estimated disease extent on imaging with final pathology. Surgery performed was recorded from patient records. RESULTS Contrast imaging modified mock-MDT plans for 20 of 61(32.8%) breasts. The addition of CEM changed the plan in 16/20 (80%) and MRI in 17/20 breasts (85%). Identical changes were proposed by both CEM and MRI in 13/20 (65%) breasts. The modified surgical plan based on CI + CEM was possibly appropriate for 6/16 (37.5%), and CI + MRI in 9/17, (52.9%) breasts. The surgery performed was concordant with the mock-MDT plan for all 10 patients where the plans could be compared (BCS 1, >1 BCS 2 and mastectomy 7). CONCLUSION Adding CEM or MRI to CI changed mock-MDT plans in up to one third of women, but not all were appropriate. Changing surgical plans following addition of contrast imaging to CI without biopsy confirmation could lead to over or under-treatment.
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Affiliation(s)
- Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- BreastScreen WA, Perth, Western Australia, Australia
| | - Max M Hobbs
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Maxine Mariri Ronald
- Department of Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sally Burrows
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Angela Ives
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Paul M Parizel
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Christobel M Saunders
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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18
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Harper LK, Faulk EA, Patel B, Collins P, Rochman C. How to Recognize and Correct Artifacts on Contrast-Enhanced Mammography. JOURNAL OF BREAST IMAGING 2023; 5:486-497. [PMID: 38416909 DOI: 10.1093/jbi/wbad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Indexed: 03/01/2024]
Abstract
Contrast-enhanced mammography (CEM) has emerged as an important new technology in breast imaging. It can demonstrate a number of imaging artifacts that have the potential to limit interpretation by either obscuring or potentially mimicking disease. Commonly encountered artifacts on CEM include patient motion artifacts (ripple and misregistration), pectoral highlighting artifact, breast implant artifact, halo artifact, corrugation artifact, cloudy fat artifact, contrast artifacts (retention and contamination), skin artifacts (skin line enhancement and skin overexposure), and skin lesions. Skin lesions may demonstrate a variety of imaging appearances and have both benign and malignant etiologies. It is important that the technologist, radiologist, and physicist be aware of potential artifacts and skin enhancement on CEM that may affect interpretation and understand their causes and potential solutions.
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Affiliation(s)
- Laura K Harper
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Ellen A Faulk
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Bhavika Patel
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Patricia Collins
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Carrie Rochman
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
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19
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Lobbes MBI, Neeter LMFH, Raat F, Turk K, Wildberger JE, van Nijnatten TJA, Nelemans PJ. The performance of contrast-enhanced mammography and breast MRI in local preoperative staging of invasive lobular breast cancer. Eur J Radiol 2023; 164:110881. [PMID: 37201248 DOI: 10.1016/j.ejrad.2023.110881] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Breast MRI is considered the best modality for preoperative staging of invasive lobular carcinoma (ILC). However, contrast-enhanced mammography (CEM) shows comparable diagnostic performance to MRI, but evidence of CEM's accuracy in women diagnosed with ILC is scant. We aimed to retrospectively evaluate CEM and MRI accuracy in preoperative staging of ILC. METHODS ILC cases diagnosed between 2013 and 2021 were collected. For both modalities, tumour diameter was extracted from the reports. Bland-Altman plots were used to assess discrepancies between size measurements according to imaging and histopathological findings. CEM and MRI's ability to detect multifocal/contralateral cancer was expressed as sensitivity, specificity, and diagnostic odds ratios (DORs). Pairwise comparison of women undergoing both CEM and MRI was not performed. RESULTS 305 ILC-cases fulfilled preset inclusion criteria. Mean age was 63.7 years. Preoperative staging was performed using MRI or CEM in 266 (87.2%) and 77 (25.2%) cases, respectively. MRI and CEM overestimated tumour size by 1.5 and 2.1 mm, respectively. Sensitivity to detect multifocal disease was higher for MRI than for CEM (86% versus 78%), but specificity was lower for MRI (79% versus 92%). For detection of contralateral breast cancer, sensitivity for MRI was 96% versus 88% for CEM, and specificity was 92% and 99%, respectively. For both indications, DOR was higher for CEM, but differences were non-significant (p = 0.56 and p = 0.78). CONCLUSION CEM and MRI overestimate ILC size with comparable systematic and random errors. MRI's higher sensitivity for detection of multifocal/contralateral cancers is accompanied by lower specificity, but discriminative ability for both modalities was non-significant.
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Affiliation(s)
- Marc B I Lobbes
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Lidewij M F H Neeter
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Frank Raat
- Laurentius Hospital, Department of Radiology, P.O. Box 920, 6040AX Roermond, the Netherlands.
| | - Kim Turk
- Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands.
| | - Joachim E Wildberger
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Thiemo J A van Nijnatten
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Patricia J Nelemans
- Maastricht University, Department of Epidemiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
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van Nijnatten TJA, Lobbes MBI, Cozzi A, Patel BK, Zuley ML, Jochelson MS. Barriers to Implementation of Contrast-Enhanced Mammography in Clinical Practice: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:3-6. [PMID: 36448912 PMCID: PMC11025563 DOI: 10.2214/ajr.22.28567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound and comparable diagnostic performance to MRI for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited because of a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These factors include the following: the risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments needed when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently mitigate or are expected to mitigate these factors are also highlighted.
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Affiliation(s)
- Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Hassan RM, Almalki YE, Basha MAA, Alduraibi SK, Aboualkheir M, Almushayti ZA, Aldhilan AS, Aly SA, Alshamy AA. The Impact of Adding Digital Breast Tomosynthesis to BI-RADS Categorization of Mammographically Equivocal Breast Lesions. Diagnostics (Basel) 2023; 13:diagnostics13081423. [PMID: 37189524 DOI: 10.3390/diagnostics13081423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Digital mammography (DM) is the cornerstone of breast cancer detection. Digital breast tomosynthesis (DBT) is an advanced imaging technique used for diagnosing and screening breast lesions, particularly in dense breasts. This study aimed to evaluate the impact of combining DBT with DM on the BI-RADS categorization of equivocal breast lesions. We prospectively evaluated 148 females with equivocal BI-RADS breast lesions (BI-RADS 0, 3, and 4) with DM. All patients underwent DBT. Two experienced radiologists analyzed the lesions. They then assigned a BI-RADS category for each lesion according to the BI-RADS 2013 lexicon, using DM, DBT, and integrated DM and DBT. We compared the results based on major radiological characteristics, BI-RADS classification, and diagnostic accuracy, using the histopathological examination of the lesions as a reference standard. The total number of lesions was 178 on DBT and 159 on DM. Nineteen lesions were discovered using DBT and were missed by DM. The final diagnoses of 178 lesions were malignant (41.6%) and benign (58.4%). Compared to DM, DBT produced 34.8% downgrading and 32% upgrading of breast lesions. Compared with DM, DBT decreased the number of BI-RADS 4 and 3. All the upgraded BI-RADS 4 lesions were confirmed to be malignant. The combination of DM and DBT improves the diagnostic accuracy of BI-RADS for evaluating and characterizing mammographic equivocal breast lesions and allows for proper BI-RADS categorization.
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Affiliation(s)
- Rania Mostafa Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | | | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt
| | - Asmaa A Alshamy
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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22
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Daniaux M, Gruber L, De Zordo T, Geiger-Gritsch S, Amort B, Santner W, Egle D, Baltzer PAT. Preoperative staging by multimodal imaging in newly diagnosed breast cancer: Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography, ultrasound, and MRI. Eur J Radiol 2023; 163:110838. [PMID: 37080064 DOI: 10.1016/j.ejrad.2023.110838] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To compare contrast-enhanced spectral mammography (CESM) with mammography (Mx), ultrasound (US), and magnetic resonance imaging (MRI) regarding breast cancer detection rate and preoperative local staging. MATERIAL AND METHODS This prospective observational, single-centre study included 128 female patients (mean age 55.8 ± 11.5 years) with a newly diagnosed malignant breast tumour during routine US and Mx were prospectively enrolled. CESM and MRI examinations were performed within the study. Analysis included interreader agreement, tumour type and grade distribution, detection rates (DR), imaging morphology, contrast-enhancement and was performed by two independent readers blinded to patient history and histopathological diagnosis. Assessment of local disease extent was compared between modalities via Bland-Altman plots. RESULTS One-hundred-and-ten tumours were classified as NST (85.9%), 4 as ILC (3.1%) and 10 as DCIS (7.8%). DR was highest for MRI (128/128, 100.0%), followed by US (124/128, 96.9%) and CESM (123/128, 96.1%) and lowest for conventional Mx (106/128, 82.8%) (p = 0.0002). Higher breast density did not negatively affect DR of US, CESM or MRI. Local tumour extent measurements based on CESM (Bland-Altman bias 6.6, standard deviation 30.2) showed comparable estimation results to MRI, surpassing Mx (23.4/43.7) and US (35.4/40.5). Even though detection of multifocality and multicentricity was highest for CESM and MRI (p < 0.0001), second-look rates, i.e., targeted US examinations after MRI or CESM, were significantly lower for CESM (10.2% of cases) compared to MRI (16.2%) with a significantly higher true positive rate for CESM (72.0%) vs. MRI (42.5%). CONCLUSION CESM is a viable alternative to MRI for lesion detection and local staging in newly diagnosed malignant breast cancer and provides higher specificity in regard to second-look examinations.
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Affiliation(s)
- Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Tobias De Zordo
- Department of Radiology, Brixsana Private Clinic, Julius-Durst-Straße 28, Brixen, Italy
| | - Sabine Geiger-Gritsch
- Medizinisches Projektmanagement, Tirol Kliniken GmbH, Anichstraße 35, Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Wolfram Santner
- Department of Radiology, Privatklinik Hirslanden, Rigistrasse 1, Cham, Switzerland
| | - Daniel Egle
- Department of Gynaecology and Obstetrics, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, Vienna, Austria
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23
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Hogan MP, Horvat JV, Ross DS, Sevilimedu V, Jochelson MS, Kirstein LJ, Goldfarb SB, Comstock CE, Sung JS. Contrast-enhanced mammography in the assessment of residual disease after neoadjuvant treatment. Breast Cancer Res Treat 2023; 198:349-359. [PMID: 36754936 PMCID: PMC10375516 DOI: 10.1007/s10549-023-06865-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE To investigate the utility of contrast-enhanced mammography (CEM) as an alternative to breast MRI for the evaluation of residual disease after neoadjuvant treatment (NAT). METHODS This prospective study enrolled consecutive women undergoing NAT for breast cancer from July 2017-July 2019. Breast MRI and CEM exams performed after completion of NAT were read independently by two breast radiologists. Residual disease and lesion size on MRI and CEM recombined (RI) and low-energy images (LEI) were compared. Histopathology was considered the reference standard. Statistical analysis was performed using McNemar's and Leisenring's tests. Multiple comparison adjustment was made using Bonferroni procedure. Lesion sizes were correlated using Kendall's tau coefficient. RESULTS There were 110 participants with 115 breast cancers. Residual disease (invasive cancer or ductal carcinoma in situ) was detected in 83/115 (72%) lesions on pathology, 71/115 (62%) on MRI, 55/115 (48%) on CEM RI, and 75/115 (65%) on CEM LEI. When using multiple comparison adjustment, no significant differences were detected between MRI combined with CEM LEI and CEM RI combined with CEM LEI, in terms of accuracy (MRI: 77%, CEM: 72%; p ≥ 0.99), sensitivity (MRI: 88%, CEM: 81%; p ≥ 0.99), specificity (MRI: 47%, CEM: 50%; p ≥ 0.99), PPV (MRI: 81%, CEM: 81%; p ≥ 0.99), or NPV (MRI: 60%, CEM: 50%; p ≥ 0.99). Size correlation between pathology and both MRI combined with CEM LEI and CEM RI combined with CEM LEI was moderate: τ = 0. 36 vs 0.33 (p ≥ 0.99). CONCLUSION Contrast-enhanced mammography is an acceptable alternative to breast MRI for the detection of residual disease after neoadjuvant treatment.
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Affiliation(s)
- Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Dara S Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10017, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laurie J Kirstein
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Shari B Goldfarb
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christopher E Comstock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Pereslucha AM, Wenger DM, Morris MF, Aydi ZB. Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance. Healthcare (Basel) 2023; 11:healthcare11050746. [PMID: 36900751 PMCID: PMC10000992 DOI: 10.3390/healthcare11050746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.
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Affiliation(s)
- Alicia M Pereslucha
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
| | - Danielle M Wenger
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA
| | - Michael F Morris
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Department of Radiology, Banner University Medical Center-Phoenix, Phoenix, AZ 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Correspondence:
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25
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Taylor DB, Burrows S, Saunders CM, Parizel PM, Ives A. Contrast-enhanced mammography (CEM) versus MRI for breast cancer staging: detection of additional malignant lesions not seen on conventional imaging. Eur Radiol Exp 2023; 7:8. [PMID: 36781808 PMCID: PMC9925630 DOI: 10.1186/s41747-022-00318-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/15/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is more available than MRI for breast cancer staging but may not be as sensitive in assessing disease extent. We compared CEM and MRI in this setting. METHODS Fifty-nine women with invasive breast cancer underwent preoperative CEM and MRI. Independent pairs of radiologists read CEM studies (after reviewing a 9-case set prior to study commencement) and MRI studies (with between 5 and 25 years of experience in breast imaging). Additional lesions were assigned National Breast Cancer Centre (NBCC) scores. Positive lesions (graded NBCC ≥ 3) likely to influence surgical management underwent ultrasound and/or needle biopsy. True-positive lesions were positive on imaging and pathology (invasive or in situ). False-positive lesions were positive on imaging but negative on pathology (high-risk or benign) or follow-up. False-negative lesions were negative on imaging (NBCC < 3 or not identified) but positive on pathology. RESULTS The 59 women had 68 biopsy-proven malignant lesions detected on mammography/ultrasound, of which MRI demonstrated 66 (97%) and CEM 67 (99%) (p = 1.000). Forty-one additional lesions were detected in 29 patients: six of 41 (15%) on CEM only, 23/41 (56%) on MRI only, 12/41 (29%) on both; CEM detected 1/6 and MRI 6/6 malignant additional lesions (p = 0.063), with a positive predictive value (PPV) of 1/13 (8%) and 6/26 (23%) (p = 0.276). CONCLUSIONS While MRI and CEM were both highly sensitive for lesions detected at mammography/ultrasound, CEM may not be as sensitive as MRI in detecting additional otherwise occult foci of malignancy. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN 12613000684729.
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Affiliation(s)
- Donna B. Taylor
- grid.416195.e0000 0004 0453 3875Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, 6000 WA Australia ,grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Sally Burrows
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Christobel M. Saunders
- grid.416153.40000 0004 0624 1200Department of Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC Australia
| | - Paul M. Parizel
- grid.416195.e0000 0004 0453 3875Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, 6000 WA Australia ,grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Angela Ives
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
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26
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Yang ML, Bhimani C, Roth R, Germaine P. Contrast enhanced mammography: focus on frequently encountered benign and malignant diagnoses. Cancer Imaging 2023; 23:10. [PMID: 36691077 PMCID: PMC9872331 DOI: 10.1186/s40644-023-00526-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Contrast-enhanced mammography (CEM) is becoming a widely adopted modality in breast imaging over the past few decades and exponentially so over the last few years, with strong evidence of high diagnostic performance in cancer detection. Evidence is also growing indicating comparative performance of CEM to MRI in sensitivity with fewer false positive rates. As application of CEM ranges from potential use in screening dense breast populations to staging of known breast malignancy, increased familiarity with the modality and its implementation, and disease processes encountered becomes of great clinical significance. This review emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM.
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Affiliation(s)
- Mindy L. Yang
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
- Present address: SimonMed Imaging, 6900 E Camelback Road, Suite 700, Scottsdale, AZ 85251 USA
| | - Chandni Bhimani
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
- Present address: Atlantic Medical Imaging, Bayport One Office Building, 8025 Black Horse Pike, Suite 300, West Atlantic City, NJ 08232 USA
| | - Robyn Roth
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
| | - Pauline Germaine
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
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27
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Emory T, Hoven N, Nelson M, Church AL, Rubin N, Kuehn-Hajder J. Diagnostic Contrast-Enhanced Mammography Performed Immediately Prior to Same-Day Biopsy: An Analysis of Index Lesion Enhancement Compared to Histopathology and Follow-up in Patients With Suspicious Ultrasound Findings. JOURNAL OF BREAST IMAGING 2023; 5:40-47. [PMID: 36778652 PMCID: PMC9901423 DOI: 10.1093/jbi/wbac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Indexed: 01/03/2023]
Abstract
Objective To measure the diagnostic performance of contrast-enhanced mammography (CEM) for the index lesion when it is performed the same day prior to biopsy in patients with suspicious findings at US. Methods This IRB-approved retrospective study compared radiologist original reports of the presence or absence of index lesion enhancement on CEM to biopsy results and follow-up. The most suspicious lesion or the larger of equally suspicious lesions recommended for biopsy by US after a diagnostic workup including mammography was considered the index lesion. CEM exams were performed the same day, immediately prior to the scheduled biopsy, as requested by the radiologist recommending the biopsy. Numeric variables were summarized with means and standard deviations, or medians and the minimum and maximum, where appropriate. Results Biopsy demonstrated cancer in 64.7% (200/309) of index lesions. Of these, 197/200 demonstrated enhancement for a sensitivity of 98.5% (95% CI: 95.7%-99.7%) (197/200) and the negative predictive value of CEM for non-enhancing index lesions was 95.1% (58/61; 95% CI: 86.1%-98.4%). The three false negative exams were two grade 1 ER+ HER2- invasive ductal cancers that were 6 mm and 7 mm in size, and a 3-mm grade 2 ductal carcinoma in situ in a complex cystic and solid mass. False positive exams made up 20.6% (51/248) of the positive exams. Conclusion Diagnostic CEM showed high sensitivity and specificity for cancer in lesions with suspicious US findings. CEM may reduce the need for some biopsies, and negative CEM may support a true negative biopsy result.
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Affiliation(s)
- Tim Emory
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Noelle Hoven
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Michael Nelson
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - An L Church
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Nathan Rubin
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
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28
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Pires-Gonçalves L, Henriques Abreu M, Ferrão A, Guimarães Dos Santos A, Aguiar AT, Gouvêa M, Henrique R. Patient perspectives on repeated contrast-enhanced mammography and magnetic resonance during neoadjuvant chemotherapy of breast cancer. Acta Radiol 2022; 64:1816-1822. [PMID: 36575580 DOI: 10.1177/02841851221144021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden perceived by the patient of repeated imaging required for neoadjuvant chemotherapy (NAC) monitoring warrants attention due to the increased use of NAC and imaging. PURPOSE To evaluate and compare the experienced burden associated with repeated contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) during NAC for breast cancer from the patient perspective. MATERIAL AND METHODS Approval from the ethics committee and written informed consent were obtained. In this prospective study, CEM and MRI were performed on 38 patients with breast cancer before, during, and after NAC in a tertiary cancer center. The experienced burden was evaluated with a self-reported questionnaire addressing duration, comfort, anxiety, positioning, and intravenous contrast administration, each measured on a 5-point Likert scale. The participants were asked their preference between CEM or MRI. Statistical comparisons were performed and P<0.05 was considered significant. RESULTS Most participants (n = 29, 76%) preferred CEM over MRI (P = 0.0008). CEM was associated with a significantly shorter duration (P < 0.001), greater overall comfort (P < 0.01), more comfortable positioning (P = 0.01), and lower anxiety (P = 0.03). Intravenous contrast administration perception revealed no significant difference. Only 4 (10%) participants preferred MRI over CEM, due to the absence of breast compression. CONCLUSION In the hypothetical scenario of equal diagnostic accuracy, most participants preferred CEM and compared CEM favorably to MRI in all investigated features at repeated imaging required for NAC response assessment. Our results indicate that repeated examinations with CEM is well tolerated and constitutes a patient-friendly alternative for NAC imaging monitoring in breast cancer.
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Affiliation(s)
- Lígia Pires-Gonçalves
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Anabela Ferrão
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | | | - Ana Teresa Aguiar
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Margarida Gouvêa
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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29
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Contrast-Enhanced Mammography Versus MRI in the Evaluation of Neoadjuvant Therapy Response in Patients With Breast Cancer: A Prospective Study. AJR Am J Roentgenol 2022; 219:884-894. [PMID: 35731101 DOI: 10.2214/ajr.22.27756] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Contrast-enhanced mammography (CEM) is rapidly expanding as a credible alternative to MRI in various clinical settings. OBJECTIVE. The purpose of this study was to compare CEM and MRI for neoadjuvant therapy (NAT) response assessment in patients with breast cancer. METHODS. This prospective study included 51 patients (mean age, 46 ± 11 [SD] years) with biopsy-proven breast cancer who were candidates for NAT from May 2015 to April 2018. Patients underwent both CEM and MRI before, during, and after NAT (pre-NAT, mid-NAT, and post-NAT, respectively). Post-NAT CEM included a 6-minute delayed acquisition. One breast radiologist with experience in CEM reviewed CEM examinations; one breast radiologist with experience in MRI reviewed MRI examinations. The radiologists assessed for the presence of an enhancing lesion; if an enhancing lesion was detected, its size was measured. RECIST version 1.1 response assessment categories were derived. Pathologic complete response (pCR) was defined as absence of both invasive cancer and ductal carcinoma in situ (DCIS). RESULTS. Of 51 patients, 16 achieved pCR. CEM yielded systematically lower size measurements compared with MRI (mean difference, -0.2 mm for pre-NAT, -0.7 mm for mid-NAT, and -0.3 mm for post-NAT). All post-NAT imaging tests yielded systematically larger size measurements compared with pathology (mean difference, 0.8 mm for CEM, 1.2 mm for MRI, and 1.9 mm for delayed CEM). Of 12 patients with residual DCIS, an enhancing lesion was detected in seven on post-NAT CEM, eight on post-NAT MRI, and nine on post-NAT delayed CEM. Agreement of RECIST response categories between CEM and MRI, expressed as kappa coefficient, was 0.791 at mid-NAT and 0.871 at post-NAT. For detecting pCR by post-NAT imaging, sensitivity and specificity were 81% and 83% for CEM, 100% and 86% for MRI, and 81% and 89% for delayed CEM. Sensitivity was significantly higher for MRI than CEM (p = .001) and delayed CEM (p = .002); remaining comparisons were not significant (p > .05). CONCLUSION. After NAT for breast cancer, CEM and MRI yielded comparable assessments of lesion size (both slightly overestimated vs pathology) and RECIST categories and showed no significant difference in specificity for pCR. MRI had higher sensitivity for pCR. Delayed CEM acquisition may help detect residual DCIS. CLINICAL IMPACT. Although MRI remains the preferred test for NAT response monitoring, the findings support CEM as a useful alternative when MRI is contraindicated or not tolerated.
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Rahman RWA, Al-Dhurani SYA, Radwan AH, Mohamed AA, Kamal EF. Multi-detector CT chest: can it omit the further need for contrast enhnaced spectral mammography in breast cancer patients candidate for CT staging? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
During multi-detector computed tomography (MDCT) of the chest, incidental breast lesions (IBLs) are occasionally encountered. Mammography remains the gold standard for the early detection of breast cancer. However, limitations exist in patients with dense breasts. Contrast spectral mammography (CESM) is widely available compared to MRI; it increases the sensitivity for breast cancer detection without decreasing the specificity.
Results
The study is a prospective study that included 113 female breast cancer patients for CT staging. One hundred and six of the patients had unilateral carcinoma and 7 of them had bilateral cancer with a total of 120 breasts evaluated. The CT findings were correlated with CESM findings regarding the multiplicity and bilaterality of the disease. The sensitivity, specificity, PPV, NPV, and accuracy of the CT in the detection of multiplicity were 97.44%, 100%, 100%, 95.45%, and 98.33%, respectively, and the sensitivity, specificity, PPV, NPV, and accuracy of the CT in the detection of bilateral disease were 68.18%, 97.96%, 88.24%, 93.20%, and 92.50%, respectively.
Conclusions
Breast cancer patients for MDCT chest as a part of their metastatic workup can omit the further need for CESM.
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Phillips J, U Achibiri J, Kim G, Quintana LM, J Mehta R, S Mehta T. Characterization of True and False Positive Findings on Contrast-Enhanced Mammography. Acad Radiol 2022; 29:1672-1681. [PMID: 35190261 DOI: 10.1016/j.acra.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this paper is to characterize true and false positive findings on contrast-enhanced mammography (CEM) and correlate enhancement pattern and method of detection with pathology outcomes. MATERIALS AND METHODS This was an IRB-approved retrospective review of diagnostic CEM performed from December 2015 through December 2019 for which biopsy was recommended. Background parenchymal enhancement, tissue density, finding features, pathologic/clinical outcomes, and method of detection were captured. CEM includes low-energy images (LE), similar to standard 2D mammography, and recombined images (RI) that show enhancement. 'MG-detected' findings were identified on mammography or LE. 'RI-detected' findings were identified due to enhancement on RI. The positive predictive value (PPV2) was calculated on a per-case and a per-finding level. Comparisons were performed using Pearson chi-square and Fisher exact tests. RESULTS One hundred sixty CEM cases with 220 findings were evaluated with a case PPV2 of 58.1%. 32.3% (71/220) of lesions were RI-detected. The PPV2 of RI-detected enhancement was 40.8% with subanalysis revealing PPV2 of 22.2%, 32%, and 51.4% for foci, NME, and masses, respectively. The PPV2 of MG-detected enhancement was 73.5% with subanalysis revealing PPV2 of 50%, 54.1%, and 83.8% for foci, NME, and masses, respectively. There were 100 false positives findings, 42 of which were RI-detected. CONCLUSION PPV2 of diagnostic CEM is within the range of other diagnostic breast imaging exams. However false positives remain a challenge, especially for RI-detected findings. Additional efforts to improve specificity of RI-detected findings are worthwhile.
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Affiliation(s)
- Jordana Phillips
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Janeiro U Achibiri
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Geunwon Kim
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Liza M Quintana
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Rashmi J Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
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Wetzl M, Dietzel M, Ohlmeyer S, Uder M, Wenkel E. Spiral breast computed tomography with a photon-counting detector (SBCT): the future of breast imaging? Eur J Radiol 2022; 157:110605. [DOI: 10.1016/j.ejrad.2022.110605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
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Nicosia L, Bozzini AC, Palma S, Montesano M, Signorelli G, Pesapane F, Latronico A, Bagnardi V, Frassoni S, Sangalli C, Farina M, Cassano E. Contrast-Enhanced Spectral Mammography and tumor size assessment: a valuable tool for appropriate surgical management of breast lesions. Radiol Med 2022; 127:1228-1234. [DOI: 10.1007/s11547-022-01561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
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Yong-Hing CJ, Gordon PB, Appavoo S, Fitzgerald SR, Seely JM. Addressing Misinformation About the Canadian Breast Screening Guidelines. Can Assoc Radiol J 2022; 74:388-397. [PMID: 36048585 DOI: 10.1177/08465371221120798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Screening mammography has been shown to reduce breast cancer mortality by 41% in screened women ages 40-69 years. There is misinformation about breast screening and the Canadian breast screening guidelines. This can decrease confidence in screening mammography and can lead to suboptimal recommendations. We review some of this misinformation to help radiologists and referring physicians navigate the varied international and provincial guidelines. We address the ages to start and stop breast screening. We explore how these recommendations may vary for specific populations such as patients who are at increased risk, transgender patients and minorities. We identify who would benefit from supplemental screening and review the available supplemental screening modalities including ultrasound, MRI, contrast-enhanced mammography and others. We describe emerging technologies including the potential use of artificial intelligence for breast screening. We provide background on why screening policies vary across the country between provinces and territories. This review is intended to help radiologists and referring physicians understand and navigate the varied international and provincial recommendations and guidelines and make the best recommendations for their patients.
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Affiliation(s)
- Charlotte J Yong-Hing
- Faculty of Medicine, Department of Radiology, 8166University of British Columbia, Vancouver, BC, Canada
| | - Paula B Gordon
- Faculty of Medicine, Department of Radiology, 8166University of British Columbia, Vancouver, BC, Canada
| | - Shushiela Appavoo
- Department of Radiology and Diagnostic Imaging, 3158University of Alberta, Edmonton, AB, Canada
| | - Sabrina R Fitzgerald
- Faculty of Medicine, Department of Radiology, 7938University of Toronto, Toronto, ON, Canada
| | - Jean M Seely
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Ontario Breast Screening Program, Ottawa, ON, Canada
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Gelardi F, Ragaini EM, Sollini M, Bernardi D, Chiti A. Contrast-Enhanced Mammography versus Breast Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:1890. [PMID: 36010240 PMCID: PMC9406751 DOI: 10.3390/diagnostics12081890] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CE-MRI) are commonly used in the screening of breast cancer. The present systematic review aimed to summarize, critically analyse, and meta-analyse the available evidence regarding the role of CE-MRI and CEM in the early detection, diagnosis, and preoperative assessment of breast cancer. METHODS The search was performed on PubMed, Google Scholar, and Web of Science on 28 July 2021 using the following terms "breast cancer", "preoperative staging", "contrast-enhanced mammography", "contrast-enhanced spectral mammography", "contrast enhanced digital mammography", "contrast-enhanced breast magnetic resonance imaging" "CEM", "CESM", "CEDM", and "CE-MRI". We selected only those papers comparing the clinical efficacy of CEM and CE-MRI. The study quality was assessed using the QUADAS-2 criteria. The pooled sensitivities and specificity of CEM and CE-MRI were computed using a random-effects model directly from the STATA "metaprop" command. The between-study statistical heterogeneity was tested (I2-statistics). RESULTS Nineteen studies were selected for this systematic review. Fifteen studies (1315 patients) were included in the metanalysis. Both CEM and CE-MRI detect breast lesions with a high sensitivity, without a significant difference in performance (97% and 96%, respectively). CONCLUSIONS Our findings confirm the potential of CEM as a supplemental screening imaging modality, even for intermediate-risk women, including females with dense breasts and a history of breast cancer.
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Affiliation(s)
- Fabrizia Gelardi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Elisa Maria Ragaini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Daniela Bernardi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
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Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes. Eur Radiol 2022; 33:417-428. [PMID: 35895121 DOI: 10.1007/s00330-022-09021-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the feasibility of contrast-enhanced mammography (CEM)-guided biopsy at Hospital del Mar, a Spanish university hospital. METHODS We retrospectively reviewed all consecutive women with a suspicious enhancing finding eligible for CEM-guided biopsy, who were prospectively enrolled in a pre-marketing clinical validation and feasibility study (October 2019 to September 2021). CEM-guided biopsy is a stereotactic-based procedure that, by using intravenous iodinated contrast media administration and dual-energy acquisition, provides localisation of enhancing lesions. All the biopsies were performed using a vacuum-assisted device. We collected procedural characteristics (patient position and type of approach), and histopathological results. Feasibility endpoints included success (visualisation of the enhancing lesion, post-procedural biopsy changes and clip placement), procedural time, number of scout acquisitions and complications. RESULTS A total of 66 suspicious enhancing lesions (18.0% foci, 44.0% mass, 38.0% non-mass enhancement; median size 8.5 mm) in 64 patients (median age 59 years, mostly minimal [48.4%] or mild [32.8%] background parenchymal enhancement) were referred for CEM-guided biopsy in the study period. The success rate was 63/66 (95.4%). Amongst successful procedures, patients were most frequently seated (52/63, 82.5%) and the preferred approach was horizontal (48/63, 76.2%). Median total time per procedure was 15 min. Median number of acquisitions needed before targeting was 2 (range 1-4). Complications consisted of hematoma (17/63, 27%) and vasovagal reaction (2/63, 3.2%). At histology, the malignancy rate was 25/63 (39.7%). CONCLUSION In this first patient series, CEM-guided breast biopsy was feasible, with success and complication rates similar to those previously reported for magnetic resonance guidance. KEY POINTS • CEM may be used to guide biopsy of enhancing lesions through a stereotactic-based procedure combined with intravenous iodinated contrast media administration and dual-energy acquisition. • In this first patient series (n = 64), the success rate of CEM-guided biopsy was above 95%, the only complications were hematoma (22.2%) and vasovagal reaction (3.2%), and median total time per procedure was 15 min. • CEM-guided biopsy is feasible and could potentially be a widely available biopsy technique for enhancing-only lesions.
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Vasselli F, Fabi A, Ferranti FR, Barba M, Botti C, Vidiri A, Tommasin S. How Dual-Energy Contrast-Enhanced Spectral Mammography Can Provide Useful Clinical Information About Prognostic Factors in Breast Cancer Patients: A Systematic Review of Literature. Front Oncol 2022; 12:859838. [PMID: 35941874 PMCID: PMC9355886 DOI: 10.3389/fonc.2022.859838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In the past decade, a new technique derived from full-field digital mammography has been developed, named contrast-enhanced spectral mammography (CESM). The aim of this study was to define the association between CESM findings and usual prognostic factors, such as estrogen receptors, progesterone receptors, HER2, and Ki67, in order to offer an updated overview of the state of the art for the early differential diagnosis of breast cancer and following personalized treatments. Materials and Methods According to the PRISMA guidelines, two electronic databases (PubMed and Scopus) were investigated, using the following keywords: breast cancer AND (CESM OR contrast enhanced spectral mammography OR contrast enhanced dual energy mammography) AND (receptors OR prognostic factors OR HER2 OR progesterone OR estrogen OR Ki67). The search was concluded in August 2021. No restriction was applied to publication dates. Results We obtained 28 articles from the research in PubMed and 114 articles from Scopus. After the removal of six replicas that were counted only once, out of 136 articles, 37 articles were reviews. Eight articles alone have tackled the relation between CESM imaging and ER, PR, HER2, and Ki67. When comparing radiological characterization of the lesions obtained by either CESM or contrast-enhanced MRI, they have a similar association with the proliferation of tumoral cells, as expressed by Ki-67. In CESM-enhanced lesions, the expression was found to be 100% for ER and 77.4% for PR, while moderate or high HER2 positivity was found in lesions with non-mass enhancement and with mass closely associated with a non-mass enhancement component. Conversely, the non-enhancing breast cancer lesions were not associated with any prognostic factor, such as ER, PR, HER2, and Ki67, which may be associated with the probability of showing enhancement. Radiomics on CESM images has the potential for non-invasive characterization of potentially heterogeneous tumors with different hormone receptor status. Conclusions CESM enhancement is associated with the proliferation of tumoral cells, as well as to the expression of estrogen and progesterone receptors. As CESM is a relatively young imaging technique, a few related works were found; this may be due to the “off-label” modality. In the next few years, the role of CESM in breast cancer diagnostics will be more thoroughly investigated.
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Affiliation(s)
- Federica Vasselli
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Romana Ferranti
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Division of Breast Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Antonello Vidiri,
| | - Silvia Tommasin
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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Niroshani S, Nakamura T, Michiru N, Negishi T. An approach to dual-energy contrast-enhanced spectral mammography (DE-CESM) using a double layer filter: dosimetric and image quality assessment. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021534. [PMID: 35730431 DOI: 10.1088/1361-6498/ac7aed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Dual-energy contrast-enhanced spectral mammography (DE-CESM) is a recently developed advanced technique in digital mammography that uses an iodinated intravenous contrast agent to assess tumor angiogenesis. The aim of this study was to investigate the diagnostic potential of DE-CESM recombined images in terms of radiation dose and image quality. A 50% fibroglandular-50% adipose, custom-made phantom with iodine inserts of 1.0 mgI cm-3, 2.0 mgI cm-3, 4.0 mgI cm-3was used for the estimation of mean glandular dose (MGD) and the image quality. Low-energy (LE) images were acquired with the W/Rh, W/Rh + 0.01 mm Cu and W/Rh + 0.5 mm Al while high energy images (HE) are acquired with the W/Rh, W/Rh + 0.06 mm Ba, W/Rh + 0.01 mm Cu, and W/Rh + 0.03 mm Ce anode filter combinations. The total MGD was reduced up to a maximum from 1.75 mGy to 1.45 mGy by using Rh + 0.01 mm Cu double-layer filter for both LE and HE imaging of 50 mm, standard 50% fibroglandular phantom compared to Rh single-layer filter with W target. The minimum total MGD reduction (1.69 mGy) was observed when Rh + 0.5 mm Al was used for LE and Rh + 0.06 mm Ba was used for HE exposure. The image quality was comparable with the single-layer filter. The use of W/Rh + 0.01 mm Cu or W/Rh + 0.5 mm Al as target/filter combination for LE exposure and W/Rh + 0.01 mm Cu for HE exposure can reduce the additional radiation dose delivered by DE-CESM without degrading the image quality.
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Affiliation(s)
- Sachila Niroshani
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Tokiko Nakamura
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Department of Radiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Nikaidou Michiru
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Toru Negishi
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Shahraki Z, Ghaffari M, Nakhaie Moghadam M, Parooie F, Salarzaei M. Preoperative evaluation of breast cancer: Contrast-enhanced mammography versus contrast-enhanced magnetic resonance imaging: A systematic review and meta-analysis. Breast Dis 2022; 41:303-315. [PMID: 35754256 DOI: 10.3233/bd-210034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Breast cancer is the most common cancer in women worldwide. It is responsible for about 23% of cancer in females in both developed and developing countries. This study aimed to compare the diagnostic performance of contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations of breast lesions. METHODS We searched for published literature in the English language in MEDLINE via PubMed and EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. Metadisc1.4 software was used for statistical analysisRESULTS:A total of 1225 patients were included. The pooled sensitivity of CEM and CEMRI was 0.946 (95% CI, 0.931-0.958) and 0.935 (95% CI, 0.920-0.949), respectively. The pooled specificity of CEM and CEMRI was 0.783 (95% CI, 0.758-0.807) and 0.715 (95% CI, 0.688-0.741), respectively. The sensitivity of CEM was the most in the United States (97%) and the specificity of CEM was the most in Brazil (88%). MRI sensitivity was the most in USA and Egypt (99%) and China had the most MRI specificity (81%) in diagnosis of breast lesions. CONCLUSION Contrast-enhanced mammography, a combination of high energy image and low energy image, can well display breast lesions and has the diagnostic efficacy equivalent to MRI. Importantly, CEM imaging shows higher specificity, positive predictive value, and diagnostic conformance rate than MRI. Despite some drawbacks such as higher irradiation and iodine usage, CEM has such advantages as convenient and fast examination, strong applicability, and low costs; thus, it can be popularized as a useful tool in breast disease.
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Affiliation(s)
- Zahra Shahraki
- Department of Obstetrics and Gynecology, Zabol University of Medical Science, Zabol, Iran
| | - Mehrangiz Ghaffari
- Department of Pathology, Zabol University of Medical Science, Zabol, Iran
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Forrai G, Kovács E, Ambrózay É, Barta M, Borbély K, Lengyel Z, Ormándi K, Péntek Z, Tünde T, Sebő É. Use of Diagnostic Imaging Modalities in Modern Screening, Diagnostics and Management of Breast Tumours 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610382. [PMID: 35755417 PMCID: PMC9214693 DOI: 10.3389/pore.2022.1610382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Breast radiologists and nuclear medicine specialists updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference in Kecskemét. A recommendation is hereby made that breast tumours should be screened, diagnosed and treated according to these guidelines. These professional guidelines include the latest technical developments and research findings, including the role of imaging methods in therapy and follow-up. It includes details on domestic development proposals and also addresses related areas (forensic medicine, media, regulations, reimbursement). The entire material has been agreed with the related medical disciplines.
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Affiliation(s)
- Gábor Forrai
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | - Eszter Kovács
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | | | | | - Katalin Borbély
- National Institute of Oncology, Budapest, Hungary
- Ministry of Human Capacities, Budapest, Hungary
| | | | | | | | - Tasnádi Tünde
- Dr Réthy Pál Member Hospital of Békés County Central Hospital, Békéscsaba, Hungary
| | - Éva Sebő
- Kenézy Gyula University Hospital, University of Debrecen, Debrecen, Hungary
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Savaridas SL, Whelehan P, Warwick VR, Vinnicombe SJ, Evans AJ. Contrast-enhanced digital breast tomosythesis and breast MRI to monitor response to neoadjuvant chemotherapy: patient tolerance and preference. Br J Radiol 2022; 95:20210779. [PMID: 35143334 PMCID: PMC10996419 DOI: 10.1259/bjr.20210779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel imaging technique, combining contrast-enhanced spectral mammography and tomosynthesis. This may offer an alternative imaging technique to breast MRI for monitoring of response to neoadjuvant chemotherapy. This paper addresses patient experience and preference regarding the two techniques. METHODS Conducted as part of a prospective pilot study; patients were asked to complete questionnaires pertaining to their experience of CE-DBT and MRI following pre-treatment and end-of-treatment imaging. Questionnaires consisted of eight questions answered on a categorical scale, two using a visual analogue scale (VAS), and a question to indicate preference of imaging technique. Statistical analysis was performed with Wilcoxon signed rank test and McNemar test for related samples using SPSS v. 25. RESULTS 18 patients were enrolled in the pilot study. Matched CE-DBT and MRI questionnaires were completed after 22 patient episodes. Patient preference was indicated after 31 patient episodes. Overall, on 77% of occasions patients preferred CE-DBT with no difference between pre-treatment and end-of-treatment imaging. Overall experience (p = 0.008), non-breast pain (p = 0.046), anxiety measured using VAS (p = 0.003), and feeling of being put at ease by staff (p = 0.023) was better for CE-DBT. However, more breast pain was experienced during CE-DBT when measured on both VAS (p = 0.011) and categorical scale (p = 0.021). CONCLUSION Our paper suggests that patients prefer CE-DBT to MRI, adding further evidence in favour of contrast-enhanced mammographic techniques. ADVANCES IN KNOWLEDGE Contrast mammographic techniques offer an alternative, more accessible imaging technique to breast MRI. Whilst other studies have addressed patient experience of contrast-enhanced spectral mammography, this is the first study to directly explore patient preference for CE-DBT over MRI in the setting of neoadjuvant chemotherapy, finding that overall, patients preferred CE-DBT despite the relatively long breast compression.
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Affiliation(s)
- Sarah L Savaridas
- School of Medicine, University of Dundee, Ninewells Hospital
& Medical School, Dundee,
UK
| | - Patsy Whelehan
- School of Medicine, University of Dundee, Ninewells Hospital
& Medical School, Dundee,
UK
| | - Violet R Warwick
- School of Medicine, University of Dundee, Ninewells Hospital
& Medical School, Dundee,
UK
| | - Sarah J Vinnicombe
- School of Medicine, University of Dundee, Ninewells Hospital
& Medical School, Dundee,
UK
- Gloucestershire Hospitals NHS Foundation Trust,
Cheltenham, UK
| | - Andrew J Evans
- School of Medicine, University of Dundee, Ninewells Hospital
& Medical School, Dundee,
UK
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The Impact of Dense Breasts on the Stage of Breast Cancer at Diagnosis: A Review and Options for Supplemental Screening. Curr Oncol 2022; 29:3595-3636. [PMID: 35621681 PMCID: PMC9140155 DOI: 10.3390/curroncol29050291] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of breast cancer screening is to find cancers early to reduce mortality and to allow successful treatment with less aggressive therapy. Mammography is the gold standard for breast cancer screening. Its efficacy in reducing mortality from breast cancer was proven in randomized controlled trials (RCTs) conducted from the early 1960s to the mid 1990s. Panels that recommend breast cancer screening guidelines have traditionally relied on the old RCTs, which did not include considerations of breast density, race/ethnicity, current hormone therapy, and other risk factors. Women do not all benefit equally from mammography. Mortality reduction is significantly lower in women with dense breasts because normal dense tissue can mask cancers on mammograms. Moreover, women with dense breasts are known to be at increased risk. To provide equity, breast cancer screening guidelines should be created with the goal of maximizing mortality reduction and allowing less aggressive therapy, which may include decreasing the interval between screening mammograms and recommending consideration of supplemental screening for women with dense breasts. This review will address the issue of dense breasts and the impact on the stage of breast cancer at the time of diagnosis, and discuss options for supplemental screening.
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Amir T, Hogan MP, Jacobs S, Sevilimedu V, Sung J, Jochelson MS. Comparison of False-Positive Versus True-Positive Findings on Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol 2022; 218:797-808. [PMID: 34817195 PMCID: PMC9110098 DOI: 10.2214/ajr.21.26847] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. Contrast-enhanced digital mammography (CEDM) has been shown to outperform standard mammography while performing comparably to contrast-enhanced MRI. OBJECTIVE. The purpose of our study was to compare imaging characteristics of false-positive and true-positive findings on CEDM. METHODS. This retrospective study included women who underwent baseline screening CEDM between January 2013 and December 2018 assessed as BI-RADS category 0, 3, 4, or 5 and who underwent biopsy with histopathologic diagnosis or had a 2-year imaging follow-up. Lesion characteristics were extracted from CEDM reports. A true-positive finding was defined as a lesion in which biopsy yielded malignancy. A false-positive finding was defined as a lesion in which biopsy yielded benign or benign high-risk pathology or in which 2-year imaging follow-up was negative. RESULTS. Of 157 patients (median age, 52 years), 24 had a total of 26 true-positive lesions, and 133 had a total of 147 false-positive lesions. Of the 26 true-positive lesions, one (4%) exhibited only a mammographic finding on low-iodine images, 13 (50%) exhibited only a contrast finding on iodine images, and 12 (46%) exhibited both a mammographic finding on low-energy images and a contrast finding on iodine images. A true-positive result was more likely (p = .02) for lesions present on both low-energy images and iodine images (31%) than on low-energy images only (4%) or iodine images only (12%). Among lesions present on both low-energy and iodine images, a true-positive result was more likely (p < .001) when the type of mammographic finding was an asymmetry (46%) or calcification (80%) than a mass (11%) or distortion (0%). A true-positive result was more likely (p = .01) among those with, versus those without, an ultrasound correlate (36% vs 9%) and also was more likely (p = .02) among those with, versus those without, an MRI correlate (18% vs 2%). Of 25 false-positive calcifications, 24 had no associated mammographic enhancement; of five true-positive calcifications, four had mammographic enhancement. CONCLUSION. A low-energy mammographic finding with associated enhancement or a finding with a sonographic or MRI correlate predicts a true-positive result. Calcifications with associated enhancement had a high malignancy rate. Nonetheless, half of true-positive lesions enhanced on iodine images without a mammographic finding on low-energy images. CLINICAL IMPACT. These observations inform radiologists' management of abnormalities detected on screening CEDM.
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Affiliation(s)
- Tali Amir
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Stefanie Jacobs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Janice Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
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Prediction of Breast Cancer Histological Outcome by Radiomics and Artificial Intelligence Analysis in Contrast-Enhanced Mammography. Cancers (Basel) 2022; 14:cancers14092132. [PMID: 35565261 PMCID: PMC9102628 DOI: 10.3390/cancers14092132] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The assessment of breast lesions through mammographic images is currently challenging, especially in dense breasts. Contrast-enhanced mammography has been shown to overcome the limitations of standard mammography but it greatly depends on the interpretative skills of the physician. The aim of this study was to evaluate the potentialities of statistical and artificial intelligence algorithms as a tool for helping the radiologists in the interpretation of images. The most remarkable results were achieved in discriminating benign from malignant lesions and in the identification of the presence of the hormone receptor. A tool to support the physician’s decision-making process may be designed starting from simple logistic regression and tree-based algorithms. This type of tool may help the radiologist in assessing the investigated breast and in choosing the appropriate follow-up without resorting to histology. Abstract Purpose: To evaluate radiomics features in order to: differentiate malignant versus benign lesions; predict low versus moderate and high grading; identify positive or negative hormone receptors; and discriminate positive versus negative human epidermal growth factor receptor 2 related to breast cancer. Methods: A total of 182 patients with known breast lesions and that underwent Contrast-Enhanced Mammography were enrolled in this retrospective study. The reference standard was pathology (118 malignant lesions and 64 benign lesions). A total of 837 textural metrics were extracted by manually segmenting the region of interest from both craniocaudally (CC) and mediolateral oblique (MLO) views. Non-parametric Wilcoxon–Mann–Whitney test, receiver operating characteristic, logistic regression and tree-based machine learning algorithms were used. The Adaptive Synthetic Sampling balancing approach was used and a feature selection process was implemented. Results: In univariate analysis, the classification of malignant versus benign lesions achieved the best performance when considering the original_gldm_DependenceNonUniformity feature extracted on CC view (accuracy of 88.98%). An accuracy of 83.65% was reached in the classification of grading, whereas a slightly lower value of accuracy (81.65%) was found in the classification of the presence of the hormone receptor; the features extracted were the original_glrlm_RunEntropy and the original_gldm_DependenceNonUniformity, respectively. The results of multivariate analysis achieved the best performances when using two or more features as predictors for classifying malignant versus benign lesions from CC view images (max test accuracy of 95.83% with a non-regularized logistic regression). Considering the features extracted from MLO view images, the best test accuracy (91.67%) was obtained when predicting the grading using a classification-tree algorithm. Combinations of only two features, extracted from both CC and MLO views, always showed test accuracy values greater than or equal to 90.00%, with the only exception being the prediction of the human epidermal growth factor receptor 2, where the best performance (test accuracy of 89.29%) was obtained with the random forest algorithm. Conclusions: The results confirm that the identification of malignant breast lesions and the differentiation of histological outcomes and some molecular subtypes of tumors (mainly positive hormone receptor tumors) can be obtained with satisfactory accuracy through both univariate and multivariate analysis of textural features extracted from Contrast-Enhanced Mammography images.
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Fusco R, Di Bernardo E, Piccirillo A, Rubulotta MR, Petrosino T, Barretta ML, Mattace Raso M, Vallone P, Raiano C, Di Giacomo R, Siani C, Avino F, Scognamiglio G, Di Bonito M, Granata V, Petrillo A. Radiomic and Artificial Intelligence Analysis with Textural Metrics Extracted by Contrast-Enhanced Mammography and Dynamic Contrast Magnetic Resonance Imaging to Detect Breast Malignant Lesions. Curr Oncol 2022; 29:1947-1966. [PMID: 35323359 PMCID: PMC8947713 DOI: 10.3390/curroncol29030159] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose:The purpose of this study was to discriminate between benign and malignant breast lesions through several classifiers using, as predictors, radiomic metrics extracted from CEM and DCE-MRI images. In order to optimize the analysis, balancing and feature selection procedures were performed. Methods: Fifty-four patients with 79 histo-pathologically proven breast lesions (48 malignant lesions and 31 benign lesions) underwent both CEM and DCE-MRI. The lesions were retrospectively analyzed with radiomic and artificial intelligence approaches. Forty-eight textural metrics were extracted, and univariate and multivariate analyses were performed: non-parametric statistical test, receiver operating characteristic (ROC) and machine learning classifiers. Results: Considering the single metrics extracted from CEM, the best predictors were KURTOSIS (area under ROC curve (AUC) = 0.71) and SKEWNESS (AUC = 0.71) calculated on late MLO view. Considering the features calculated from DCE-MRI, the best predictors were RANGE (AUC = 0.72), ENERGY (AUC = 0.72), ENTROPY (AUC = 0.70) and GLN (gray-level nonuniformity) of the gray-level run-length matrix (AUC = 0.72). Considering the analysis with classifiers and an unbalanced dataset, no significant results were obtained. After the balancing and feature selection procedures, higher values of accuracy, specificity and AUC were reached. The best performance was obtained considering 18 robust features among all metrics derived from CEM and DCE-MRI, using a linear discriminant analysis (accuracy of 0.84 and AUC = 0.88). Conclusions: Classifiers, adjusted with adaptive synthetic sampling and feature selection, allowed for increased diagnostic performance of CEM and DCE-MRI in the differentiation between benign and malignant lesions.
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Affiliation(s)
- Roberta Fusco
- Medical Oncolody Division, Igea SpA, 80013 Naples, Italy; (R.F.); (E.D.B.)
| | - Elio Di Bernardo
- Medical Oncolody Division, Igea SpA, 80013 Naples, Italy; (R.F.); (E.D.B.)
| | - Adele Piccirillo
- Department of Electrical Engineering and Information Technologies, Università degli Studi di Napoli Federico II, 80125 Naples, Italy;
| | - Maria Rosaria Rubulotta
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
| | - Teresa Petrosino
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
| | - Maria Luisa Barretta
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
| | - Mauro Mattace Raso
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
| | - Paolo Vallone
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
| | - Concetta Raiano
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
| | - Raimondo Di Giacomo
- Senology Surgical Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.G.); (C.S.); (F.A.)
| | - Claudio Siani
- Senology Surgical Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.G.); (C.S.); (F.A.)
| | - Franca Avino
- Senology Surgical Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.G.); (C.S.); (F.A.)
| | - Giosuè Scognamiglio
- Pathology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (G.S.); (M.D.B.)
| | - Maurizio Di Bonito
- Pathology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (G.S.); (M.D.B.)
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
- Correspondence: ; Tel.: +39-081-590-714; Fax: +39-081-590-3825
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (M.R.R.); (T.P.); (M.L.B.); (M.M.R.); (P.V.); (C.R.); (A.P.)
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Waller J, DeStefano K, Chiu B, Jang I, Cole Y, Agyemang C, Miao T, Shah J, Martin C, Umair M. An update on nanoparticle usage in breast cancer imaging. NANO SELECT 2022. [DOI: 10.1002/nano.202100320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Joseph Waller
- Drexel University College of Medicine Philadelphia USA
| | | | | | | | - Yonesha Cole
- Drexel University College of Medicine Philadelphia USA
| | | | - Tyler Miao
- University of California Los Angeles USA
| | - Jaffer Shah
- Medical Research Center Kateb University Kabul Afghanistan
- New York State Department of Health New York USA
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Bicchierai G, Busoni S, Tortoli P, Bettarini S, Naro FD, De Benedetto D, Savi E, Bellini C, Miele V, Nori J. Single Center Evaluation of Comparative Breast Radiation dose of Contrast Enhanced Digital Mammography (CEDM), Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT). Acad Radiol 2022; 29:1342-1349. [PMID: 35065889 DOI: 10.1016/j.acra.2021.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this retrospective study is to compare the radiation dose received during CEDM, short and long protocol (CEDM SP and CEDM LP), with dose received during DM and DBT on patients with varying breast thickness, age and density. MATERIALS AND METHODS Between January 2019 and December 2019, patients having 6214 DM, 3662 DBT and 173 CEDM examinations in our department were analyzed. Protocol total single breast AGD has been evaluated for all clinical imaging protocols, extracting AGD values and exposure data from the dose DICOM Structured Report (SR) information stored in the hospital PACS system. Protocol AGD was calculated as the sum of single projection AGDs carried out in every exam for each clinical protocol. A total amount of 23,383 exams for each breast were analyzed. Protocol AGDs, stratified as a function of patient breast compression thickness, age, and breast density were assessed. RESULTS The total protocol AGD median values for each protocol are: 2.8 mGy for DM, 3.2 mGy for DBT, 6.0 mGy for DM+DBT, 4.5 mGy for CEDM SP, 7.4 mGy for CEDM SP_DBT (CEDM SP protocol with DBT), 8.4 mGy for CEDM LP and 11.6 mGy for CEDM LP_DBT (CEDM LP protocol with DBT). CEDM SP AGD median value is 59% higher than DM AGD median value and 40% lesser than DM+DBT AGD median; this last difference was statistically confirmed with a p-value <0.001. AGD value for each standard breast CEDM SP projection results to be below 3-mGy limit. AGD value for each standard breast CEDM SP projection results to be below 3 mGy, as required by international legislation. For dense breasts, the AGD median value is 4.2 mGy, with the first and third quartile of 3.3 mGy and 6.0 mGy respectively; for non-dense breasts, the AGD median value is 4.7 mGy, with first and third quartile of 3.5 mGy and 6.3 mGy respectively. The difference between the two groups was statistically tested and confirmed, with a p-value of 0.039. CONCLUSION CEDM SP results in higher radiation exposure compared with conventional DM and DBT but lower than the Combo mode. The dose administered during the CEDM SP is lower in patients with dense breasts regardless of their size. An interesting outcome, considering the ongoing studies on CEDM screening in patients with dense breasts.
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Son D, Phillips J, Mehta TS, Mehta R, Brook A, Dialani VM. Patient preferences regarding use of contrast-enhanced imaging for breast cancer screening. Acad Radiol 2022; 29 Suppl 1:S229-S238. [PMID: 33846061 DOI: 10.1016/j.acra.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Our purpose is to understand patient preferences towards contrast-enhanced imaging such as CEM or MRI for breast cancer screening. METHODS AND MATERIALS An anonymous survey was offered to all patients having screening mammography at a single academic institution from December 27 th 2019 to March 6 th 2020. Survey questions related to: (1) patients' background experiences (2) patients' concern for aspects of MRI and CEM measured using a 5-point Likert scale, and (3) financial considerations. RESULTS 75% (1011/1349) patients completed the survey. 53.0% reported dense breasts and of those, 47.6% had additional screening. 49.6% had experienced a callback, 29.0% had a benign biopsy, and 13.7% had prior CEM/MRI. 34.7% were satisfied with mammography for screening. A majority were neutral or not concerned with radiation exposure, contrast allergy, IV line placement, claustrophobia, and false positive exams. 54.7% were willing to pay at least $250-500 for screening MRI. Those reporting dense breasts were less satisfied with mammography for screening (p<0.001) and willing to pay more for MRI (p<0.001). If patients had prior CEM/MRI, there was less concern for an allergic reaction (p<0.001), IV placement (p=0.025), and claustrophobia (p=0.006). There was less concern for false positives if they had a prior benign biopsy (p=0.029) or prior CEM/MRI (p=0.005) and less concern for IV placement if they had dense breasts (p=0.007) or a previous callback (p=0.013). CONCLUSION The screening population may accept CEM or MRI as a screening exam despite its risks and cost, especially patients with dense breasts and patients who have had prior CEM/MRI.
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Breast cancer in dense breasts: comparative diagnostic merits of contrast-enhanced mammography and diffusion-weighted breast MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00442-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
The study was done to compare the value of contrast-enhanced mammography and diffusion-weighted breast MRI in dense breast screening and accurate detection of the breast cancer with correlation of the findings to the histopathological results.
The study included 32 female patients having suspicious breast lesions and underwent digital mammography then scheduled for CESM and MRI DW imaging technique. The imaging findings were correlated to the histopathological findings.
Results
The study was conducted on 40 breast lesions in 32 female patients having dense breasts; they were classified by the digital mammography into ACR C (59.4%) and ACR D (40.6%). By CESM, there were twenty three lesions (57.5%) as mass lesions and thirteen lesions (32.5%) as non-mass lesions. Four lesions (10%) showed no contrast enhancement. According to the lesion characteristics in diffusion-weighted imaging, the breast lesions were classified into thirty three lesions (82.5%) with restricted diffusion and seven lesions (17.5%) with non-restricted diffusion. The study showed a cutoff ADC value to detect the malignant lesions in the dense breasts ≤ 1.1 × 10-3 s/mm2 at b value of 1000 s/mm2 with a sensitivity of 96.77%, specificity of 66.67%, PPV of 96.77%, NPV of 55.55%, and an overall total accuracy of 92.5%.
On comparing the diagnostic accuracy of the CESM to that of the DW MRI, the sensitivity of DW MRI (96.77%) was higher than that of CESM (90.32%). The specificity of DW MRI (66.67%) was higher than that of CESM (33.33%). Total accuracy of DW MRI was higher than that of CESM; they were 90% and 77.5%, respectively. Also, PPV and NPV of DW MRI were 90.91 and 85.71% as compared with 82.35 and 50.00% in CESM, respectively. When comparing the sensitivity of CESM to DW MRI in the detection of multiple breast lesions, they were 88.8 and 100%, respectively.
Conclusion
CESM is a useful technique in identification of hidden lesions in mammographically dense breasts. DW MRI is a fast, unenhanced modality that can be used as a breast cancer screening modality. CESM and DWI demonstrated good overall diagnostic accuracy in dense breast patients; however, DW MRI has a higher diagnostic accuracy than CESM for the detection of malignant breast lesions and their multiplicity.
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Woodard S, Murray A. Contrast-Enhanced Mammography: Reviewing the Past and Looking to the Future. Semin Roentgenol 2021; 57:126-133. [DOI: 10.1053/j.ro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
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