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Grimm LJ, Saha A, Ghate SV, Kim C, Soo MS, Yoon SC, Mazurowski MA. Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk. Acad Radiol 2019; 26:69-75. [PMID: 29602724 DOI: 10.1016/j.acra.2018.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 01/10/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer. MATERIALS AND METHODS All screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts. RESULTS Cancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3-4.8, P = .005). There was fair interreader agreement (κ = 0.39). CONCLUSIONS High-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
| | - Ashirbani Saha
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hock Plaza, Durham, North Carolina
| | - Sujata V Ghate
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Connie Kim
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Sora C Yoon
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Maciej A Mazurowski
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hock Plaza, Durham, North Carolina
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Breast Lesions Detected via Molecular Breast Imaging: Physiological Parameters Affecting Interpretation. Acad Radiol 2018; 25:1568-1576. [PMID: 29580791 DOI: 10.1016/j.acra.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate correlations between molecular breast imaging (MBI) descriptor characteristics and positive predictive value (PPV) in detecting breast cancer. MATERIALS AND METHODS A retrospective review was performed on 193 suspicious findings from 153 women (31-81 years) with positive MBI examinations. We assessed associations between (i) lesion pattern (mass vs. nonmass) and PPV; (ii) lesion pattern and suspected likelihood of cancer (low vs. moderate vs. high); (iii) background parenchymal uptake (BPU) (homogeneous vs. heterogeneous) and PPV; (iv) breast density (dense vs. non-dense) and PPV; and (v) BPU and density. RESULTS One hundred ten of 153 patients were diagnosed with malignancy or high-risk pathology (PPV1 = 71.9%), and 130/193 biopsies resulted in malignant or high-risk lesions (PPV3 = 67.4%). Biopsies of mass vs. nonmass findings had comparable PPV3 (71.7% vs. 61.3%; P = .0717). Mass findings were correlated with higher suspicion for cancer than nonmass findings (P < .001). There was no significant difference in PPV3 when comparing biopsies from homogeneous vs. heterogeneous BPU (72.5% vs. 60.7%; P = .103). No association was found between patients' BPU and diagnosed cancer or high-risk lesions (P = .513). Biopsies from nondense breasts demonstrated higher PPV3 than biopsies from dense breasts (85.4% vs. 60.6%; P = .0025); patients with nondense breasts were more likely to be diagnosed with cancer or high-risk pathology (PPV1 = 87.8% vs. 66.0%; P = .00844). Dense breasts had a greater association with heterogeneous BPU (P = .0844). CONCLUSION Neither variability in mass or nonmass positive MBI findings, nor variability in BPU on MBI were significant determinants for the probability of malignancy. Dense breasts were associated with lower predictability and heterogeneous BPU on MBI.
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Choi EK, Im JJ, Park CS, Chung YA, Kim K, Oh JK. Usefulness of feature analysis of breast-specific gamma imaging for predicting malignancy. Eur Radiol 2018; 28:5195-5202. [DOI: 10.1007/s00330-018-5563-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
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Breast-specific gamma imaging of invasive breast cancer: Clinicopathologic factors affecting detectability and correlation with mammographic findings. Clin Imaging 2018; 51:168-173. [PMID: 29857225 DOI: 10.1016/j.clinimag.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the factors affecting detectability of invasive breast cancers on BSGI. MATERIAL AND METHODS We evaluated BSGI, mammography and pathologic reports of 89 patients with invasive breast cancers. RESULTS 87.6% were visible on BSGI. Cancer in old or postmenopausal women were more visible on BSGI (p = 0.003, 0.046). Cancers ≥ 1.0 cm in size were significantly more visible on BSGI than those <1 cm in size (p = 0.002). Cancers in fatty breasts were more visible than those in dense breasts (p = 0.042). CONCLUSION Invasive cancers in older, postmenopausal patients, cancers with size ≥1.0 cm, and those with fatty breast are better visualized by BSGI, than those in younger, premenopausal patients, with size <1.0 cm and dense breast.
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Homma T, Manabe O, Ichinokawa K, Yamashita H, Oyama-Manabe N, Kato F, Hirata K, Kroenke M, Tamaki N. Breast cancer detected as an incidental finding on 99mTc-MIBI scintigraphy. Acta Radiol Open 2017; 6:2058460117715665. [PMID: 28804641 PMCID: PMC5533265 DOI: 10.1177/2058460117715665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/24/2017] [Indexed: 11/29/2022] Open
Abstract
We report a case of breast cancer detected as an incidental finding on 99mTc-MIBI scintigraphy. 99mTc-MIBI scintigraphy is usually used to evaluate cardiac perfusion or to detect ectopic parathyroid adenomas; however, it is also known to sensitively detect breast cancer. Accordingly, a few reports have described the incidental detection of breast cancer by 99mTc-MIBI scintigraphy performed to detect parathyroid adenoma. Our present case underscores the importance of attending to any incidental findings when searching for parathyroid adenomas using 99mTc-MIBI scintigraphy.
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Affiliation(s)
- Toshihiro Homma
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuomi Ichinokawa
- Department of Breast Surgery, Division of Surgery, Hokkaido University, Sapporo, Japan
| | - Hiroko Yamashita
- Department of Breast Surgery, Division of Surgery, Hokkaido University, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Bignotti B, Signori A, Valdora F, Rossi F, Calabrese M, Durando M, Mariscotto G, Tagliafico A. Evaluation of background parenchymal enhancement on breast MRI: a systematic review. Br J Radiol 2016; 90:20160542. [PMID: 27925480 DOI: 10.1259/bjr.20160542] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To perform a systematic review of the methods used for background parenchymal enhancement (BPE) evaluation on breast MRI. METHODS Studies dealing with BPE assessment on breast MRI were retrieved from major medical libraries independently by four reviewers up to 6 October 2015. The keywords used for database searching are "background parenchymal enhancement", "parenchymal enhancement", "MRI" and "breast". The studies were included if qualitative and/or quantitative methods for BPE assessment were described. RESULTS Of the 420 studies identified, a total of 52 articles were included in the systematic review. 28 studies performed only a qualitative assessment of BPE, 13 studies performed only a quantitative assessment and 11 studies performed both qualitative and quantitative assessments. A wide heterogeneity was found in the MRI sequences and in the quantitative methods used for BPE assessment. CONCLUSION A wide variability exists in the quantitative evaluation of BPE on breast MRI. More studies focused on a reliable and comparable method for quantitative BPE assessment are needed. Advances in knowledge: More studies focused on a quantitative BPE assessment are needed.
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Affiliation(s)
- Bianca Bignotti
- 2 Department of Health Sciences, Institute of Statistics, University of Genoa, Genoa, Italy
| | - Alessio Signori
- 3 Department of Experimental Medicine, Institute of Anatomy, University of Genoa, Genoa, Italy
| | | | - Federica Rossi
- 1 Department of Health Sciences, University of Genova, Genoa, Italy
| | - Massimo Calabrese
- 5 IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Manuela Durando
- 6 Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza of Turin, Breast Imaging Service, Division of Radiology, University of Turin, Turin, Italy
| | - Giovanna Mariscotto
- 6 Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza of Turin, Breast Imaging Service, Division of Radiology, University of Turin, Turin, Italy
| | - Alberto Tagliafico
- 3 Department of Experimental Medicine, Institute of Anatomy, University of Genoa, Genoa, Italy.,5 IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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Yoo J, Yoon HJ, Kim BS. Prognostic value of primary tumor SUV max on F-18 FDG PET/CT compared with semi-quantitative tumor uptake on Tc-99m sestamibi breast-specific gamma imaging in invasive ductal breast cancer. Ann Nucl Med 2016; 31:19-28. [PMID: 27645144 DOI: 10.1007/s12149-016-1127-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/11/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the prognostic value of F-18 FDG PET/CT in comparison with Tc-99m sestamibi breast-specific gamma imaging (BSGI) and previously established clinical prognostic parameters of invasive ductal breast carcinoma (IDC). METHODS We retrospectively included 157 female IDC patients (mean age 49.2 years, range 29.9-78.9) who underwent PET/CT and BSGI. The maximum standardized uptake value (SUVmax) and tumor to normal background ratios (TNRs) of their primary tumors were measured on PET/CT and BSGI, respectively. Univariate and multivariate survival analyses were performed to evaluate the prognostic value of the measured parameters and other clinical prognostic factors: age, menopausal status, breast density, pathologic tumor size (pTS), axillary nodal status (ANS), nuclear grade, histologic grade, hormone receptor status of estrogen (ER) and progesterone receptors (PR) and HER-2 expression. RESULTS Among 157 patients, recurrences occurred in 22 patients (14.0 %). In univariate analyses, pTS (p < 0.0001), ANS (p < 0.0001), nuclear grade (p = 0.0046), histologic grade (p = 0.0001), ER status (p < 0.0001), PR status (p = 0.0037), HER-2 status (p = 0.0007), primary tumor SUVmax (p < 0.0001) and TNR (p = 0.0001) were significant predictors of recurrence. Among them, pTS (p = 0.0172), ANS (p = 0.0416), ER status (p = 0.0375) and primary tumor SUVmax (p = 0.0239) were independent prognostic factors in multivariate regression analysis. CONCLUSIONS High primary tumor SUVmax of PET/CT and high TNR of BSGI were poor prognostic factors in IDC patients; in addition, primary tumor SUVmax was an independent prognostic factor along with pTS, ANS and ER status.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea.
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Dalm SU, Melis M, Emmering J, Kwekkeboom DJ, de Jong M. Breast cancer imaging using radiolabelled somatostatin analogues. Nucl Med Biol 2016; 43:559-565. [DOI: 10.1016/j.nucmedbio.2016.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/12/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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Hahn SY, Ko ES, Han BK, Lim Y, Gu S, Ko EY. Analysis of factors influencing the degree of detectability on diffusion-weighted MRI and diffusion background signals in patients with invasive breast cancer. Medicine (Baltimore) 2016; 95:e4086. [PMID: 27399100 PMCID: PMC5058829 DOI: 10.1097/md.0000000000004086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To determine the factors influencing the degree of detectability of lesions and diffusion background signals on magnetic resonance diffusion-weighted imaging (DWI) in invasive breast cancer.Institutional review board approval was obtained and patient consent was waived. Patients with newly diagnosed invasive ductal carcinoma, who underwent preoperative breast magnetic resonance imaging with DWI were included in this study (n = 167). Lesion detectability on DWI and contrast-enhanced subtracted T1-weighted images, the degree of background parenchymal enhancement (BPE), and diffusion background signal were qualitatively rated. Detectability of lesions on DWI was compared with clinicopathological findings including menopausal status, mammographic density, and molecular subtype of breast cancer. Multivariate linear regression analysis was performed to determine variables independently associated with detectability of lesions on DWI and diffusion background signals.Univariate analysis showed that the detectability of lesions on DWI was significantly associated with lesion size (P = 0.001), diffuse background signal (P < 0.0001), and higher detectability scores for contrast-enhanced T1-weighted subtraction images (P = 0.000). The degree of diffusion background signal was significantly affected by age (P < 0.0001), BPE (P < 0.0001), mammographic density (P = 0.002), and menopausal status (P < 0.0001). On multivariate analysis, the diffusion background signal (P < 0.0001) and histologic grade (P < 0.0001) were correlated with the detectability on DWI of invasive breast cancer. Only BPE was correlated with the amount of diffusion background signal on DWI (P < 0.0001).For invasive breast cancers, detectability on DWI was significantly affected by the diffusion background signal. BPE, menopausal status, menstrual cycle, or mammographic density did not show statistically significant correlation with the diffusion detectability of lesions on DWI.
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Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Yaeji Lim
- Department of Statistics, Pukyong National University, Busan
| | - Seonhye Gu
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
- Correspondence: Eun Sook Ko, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea (e-mail: )
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Even-Sapir E, Golan O, Menes T, Weinstein Y, Lerman H. Breast Imaging Utilizing Dedicated Gamma Camera and (99m)Tc-MIBI: Experience at the Tel Aviv Medical Center and Review of the Literature Breast Imaging. Semin Nucl Med 2016; 46:286-93. [PMID: 27237439 DOI: 10.1053/j.semnuclmed.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The scope of the current article is the clinical role of gamma cameras dedicated for breast imaging and (99m)Tc-MIBI tumor-seeking tracer, as both a screening modality among a healthy population and as a diagnostic modality in patients with breast cancer. Such cameras are now commercially available. The technology utilizing a camera composed of a NaI (Tl) detector is termed breast-specific gamma imaging. The technology of dual-headed camera composed of semiconductor cadmium zinc telluride detectors that directly converts gamma-ray energy into electronic signals is termed molecular breast imaging. Molecular breast imaging system has been installed at the Department of Nuclear medicine at the Tel Aviv Sourasky Medical Center, Tel Aviv in 2009. The article reviews the literature well as our own experience.
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Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Golan
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast Imaging Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast surgery unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuliana Weinstein
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast Imaging Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hedva Lerman
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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