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Grubstein A, Friehmann T, Dahan M, Abitbol C, Gadiel I, Schejtman DM, Shochat T, Atar E, Tamir S. Digital Breast Tomosynthesis for Upgraded BIRADS Scoring towards the True Pathology of Lesions Detected by Contrast-Enhanced Mammography. Tomography 2024; 10:806-815. [PMID: 38787021 PMCID: PMC11125662 DOI: 10.3390/tomography10050061] [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: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE To determine the added value of digital breast tomosynthesis (DBT) in the assessment of lesions detected by contrast-enhanced mammography (CEM). MATERIAL AND METHODS A retrospective study was conducted in a tertiary university medical center. All CEM studies including DBT performed between January 2016 and December 2020 were included. Lesions were categorized and scored by four dedicated breast radiologists according to the recent CEM and DBT supplements to the Breast Imaging Reporting and Data System (BIRADS) lexicon. Changes in the BIRADS score of CEM-detected lesions with the addition of DBT were evaluated according to the pathology results and 1-year follow-up imaging study. RESULTS BIRADS scores of CEM-detected lesions were upgraded toward the lesion's pathology with the addition of DBT (p > 0.0001), overall and for each reader. The difference in BIRADS scores before and after the addition of DBT was more significant for readers who were less experienced. The reason for changes in the BIRADS score was better lesion margin visibility. The main BIRADS descriptors applied in the malignant lesions were spiculations, calcifications, architectural distortion, and sharp or obscured margins. CONCLUSIONS The addition of DBT to CEM provides valuable information on the enhancing lesion, leading to a more accurate BIRADS score.
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Affiliation(s)
- Ahuva Grubstein
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Tal Friehmann
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Marva Dahan
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Chen Abitbol
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Ithai Gadiel
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Dario M. Schejtman
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Tzippy Shochat
- Biostatistics, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel;
| | - Eli Atar
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Shlomit Tamir
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
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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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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: 0] [Impact Index Per Article: 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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Savaridas SL, Jin H. Costing analysis to introduce a contrast-enhanced mammography service to replace an existing breast MRI service for local staging of breast cancer. Clin Radiol 2023; 78:340-346. [PMID: 36804270 DOI: 10.1016/j.crad.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
AIM To assess the cost impact of switching from contrast-enhanced magnetic resonance imaging (CE-MRI) to contrast-enhanced spectral mammography (CESM) for loco-regional staging of breast cancer from a public healthcare perspective. MATERIALS AND METHODS The CE-MRI cost was obtained from the NHS reference cost. The CESM cost was calculated using a bottom-up approach including use of the machine, pump injector, contrast medium, image storage, and time allocation for staff reporting and cannulation. The cost of upgrading existing machines to CESM or purchasing new mammographic machines was obtained via national procurement. Other costs were obtained from local pharmacy, published unit cost data, or estimated based on surveys. RESULTS For large health boards in Scotland (≥500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £64,069 to £81,570. For small health boards (<500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £6,453 to £23,953. The cost savings are most sensitive to the number of tests conducted per year, and whether the existing mammography machine can be upgraded to CESM or not. CONCLUSION Switching from CE-MRI to CESM for loco-regional staging of breast cancer is likely to be cost saving for both large and small health boards in Scotland. Further research is urgently needed to confirm the non-inferiority of CESM to CE-MRI as a locoregional staging technique. The input data of this analysis can be updated when such results become available.
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Affiliation(s)
- S L Savaridas
- School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
| | - H Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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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] [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
- grid.411896.30000 0004 0384 9827Department 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
- grid.411896.30000 0004 0384 9827Department 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
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
| | - Pauline Germaine
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
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Niroshani S, Nakamura T, Michiru N, Negishi T. Evaluation of exposure factors of dual-energy contrast-enhanced mammography to optimize radiation dose with improved image quality. Acta Radiol Open 2022; 11:20584601221117251. [PMID: 35983293 PMCID: PMC9379970 DOI: 10.1177/20584601221117251] [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: 05/03/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Dual-energy contrast-enhanced mammography (DECEM) is an advanced breast
imaging technique of digital mammography. Purpose To assess the total radiation dose received from complete DECEM using
different combinations of exposure parameters for low- and high-energy
images. Materials and methods A dedicated phantom with three different concentrations of iodine inserts was
used. Each iodine insert was 10 mm in diameter and concentration of
1.0 mgI/cm3, 2.0 mgI/cm3, and
4.0 mgI/cm3. The phantom was exposed at varying kVp levels.
Mean glandular dose (MGD) was estimated. Contrast to noise ratio (CNR) and
figure of merit (FOM) of the iodine inserts were used to assess the image
quality. Results The optimum CNR of the recombined images was obtained by using 28 kVp +
49 kVp tube voltage combination for 50 mm thickness, 50% fibroglandular
phantom only with a 26% dose increase compared to the highest voltages
(32 kVp + 49 kVp) that can be used for low energy (LE) and high energy (HE)
imaging. The CNR value was increased with increasing iodine concentration
(R2 > 0.99). Conclusion The use of as low as possible tube voltage for the LE imaging of standard 50%
fibroglandular–50% adipose, 50 mm thickness breast while using the highest
tube voltage for HE imaging has reduced the MGD while keeping optimum 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, 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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Can Contrast-Enhanced Spectral Mammography (CESM) Reduce Benign Breast Biopsy? Breast J 2022; 2022:7087408. [PMID: 35711887 PMCID: PMC9187292 DOI: 10.1155/2022/7087408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022]
Abstract
Objectives To evaluate the potential of contrast-enhanced spectral mammography (CESM) in reducing benign breast biopsy rate, thereby improving resource utilization. To explore its potential as a value-adding modality in the management of BI-RADS 4/5 lesions. Materials and Methods This was a prospective study conducted between July 2016 and September 2018. Patients with BI-RADS 4/5 lesions detected on conventional imaging (mammogram, digital breast tomosynthesis, and ultrasound) were enrolled for adjunct CESM. Histopathologic correlation was done for all lesions. Additional suspicious lesions detected on CESM were all identified on second-look ultrasound and subsequently biopsied. Images were evaluated independently by two radiologists trained in breast imaging using BI-RADS classification. Presence of enhancement on CESM, BI-RADS score, and histopathology of each lesion were analyzed and tested with the chi-square/fisher-exact test for statistical significance. Results The study included 105 lesions in 63 participants—1 man and 62 women, an average age of 53.7 ± 10.8 years. On CESM, 22 (20.9%) of the lesions did not show enhancement. All 22 lesions had been classified as BI-RADS 4A and were subsequently proven to be benign. Of the remaining 83 enhancing lesions, 54 (65.1%) were malignant and 29 (34.9%) were benign (p < 0.05). CESM detected 6 additional lesions which were not identified on initial conventional imaging. Four of these were proven malignant and were in a different quadrant than the primary lesion investigated. Conclusion There is evidence that the absence of enhancement in CESM strongly favors benignity. It may provide the reporting radiologist with greater confidence in imaging assessment, especially in BI-RADS 4A cases, where a proportion of them are in actuality BI-RADS 3. Greater accuracy of BI-RADS grading can reduce nearly half of benign biopsies and allow better resource allocation. CESM also increases the detection rate of potentially malignant lesions, thereby changing the treatment strategies.
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Quantifying lesion enhancement on contrast-enhanced mammography: a review of published data. Clin Radiol 2022; 77:e313-e320. [DOI: 10.1016/j.crad.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022]
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9
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Avramova-Cholakova S, Kulama E, Daskalov S, Loveland J. PERFORMANCE COMPARISON OF SYSTEMS WITH FULL-FIELD DIGITAL MAMMOGRAPHY, DIGITAL BREAST TOMOSYNTHESIS AND CONTRAST-ENHANCED SPECTRAL MAMMOGRAPHY. RADIATION PROTECTION DOSIMETRY 2021; 197:212-229. [PMID: 34977945 DOI: 10.1093/rpd/ncab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
The purpose is to compare full-field digital mammography (FFDM), digital breast tomosynthesis (DBT) and contrast-enhanced spectral mammography (CESM) technologies on three mammography systems in terms of image quality and patient dose. Two Senographe Essential with DBT and CESM (denoted S1 and S2) and one Selenia Dimensions (S3) with FFDM and DBT were considered. Dosimetry methods recommended in the European protocol were used. Image quality was tested with CDMAM in FFDM and DBT and with ideal observer method in FFDM. Mean values of mean glandular dose (MGD) from whole patient samples on S1, S2 and S3 were as follows: FFDM 1.65, 1.84 and 2.23 mGy; DBT 2.03, 1.96 and 2.87 mGy; CESM 2.65 and 3.16 mGy, respectively. S3 exhibited better low-contrast detectability for the smallest sized discs of CDMAM and ideal observer in FFDM, and for the largest sized discs in DBT, at similar dose levels.
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Neeter LM, Raat H(F, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open 2021; 3:20210034. [PMID: 34877457 PMCID: PMC8611680 DOI: 10.1259/bjro.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.
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Affiliation(s)
| | - H.P.J. (Frank) Raat
- Department of Medical Imaging, Laurentius Hospital, Roermond, the Netherlands
| | | | - Quirien Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Haggag MA, Hamed ST, Mawas ASAEL. Primary breast edema on contrast-enhanced digital mammography: a preliminary experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00585-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary breast edema can cause marked increase in skin thickness, breast density and echogenicity due to dense breast tissue filled with fluid and so causes subsequent significant attenuation of both the x-ray and ultrasound beams. The study aim is to assess the value of contrast-enhanced digital mammography (CEDM) in assessment and characterization of the obscured underlying breast lesions in cases of primary breast edema.
Results
Fifty five female participants were evaluated, of median age 51 years old and IQR 21. CEDM shows high sensitivity and specificity in the lesion detection as well as local extension delineation in cases associated with primary breast edema. It was accurate in detection of multifocal/multi-centric disease. CEDM is considered as a good negative test in cases of metastatic axillary lymph nodes to exclude and assess any associated obscured breast lesions, as it is good in delineating breast masses obscured by condensed parenchymal tissue. The calculated sensitivity of DM & CEDM was 87.5%, 95.8%, specificity was 55.5%, 72%, the PPV and NPV were 91, 93.6% and 45%, 77.8%, respectively.
Conclusions
CEDM has an important additional diagnostic value in the assessment, characterization and better delineation of breast lesions in primary edematous breast cases.
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12
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Zhang Y, Song L, Zhang H, Liu F, Hao G, Liu J, Xie H, Shi H. Giant epidermal inclusion cyst with infection arising within the breast parenchyma: a case report. J Int Med Res 2021; 49:300060521997671. [PMID: 33730901 PMCID: PMC8166397 DOI: 10.1177/0300060521997671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Epidermal inclusion cysts (EICs) of the breast develop in the deep breast parenchyma, and they are very rare. Only about 10 cases have been reported in the English-language literature to date. In this report, we present a rare case of a giant EIC with infection arising within the deep breast parenchyma. Unlike a typical EIC of the breast, the EIC in the present case was a cystic and solid lesion containing a large amount of liquid within the cyst and popcorn-like calcification in the wall. In this report, we describe the contrast-enhanced spectral mammography (CESM), ultrasonography, and computed tomography findings and provide a reference for the diagnosis of EICs. To the best of our knowledge, this is the first report of the CESM findings of an EIC. Our case illustrates that CESM has excellent performance similar to that of magnetic resonance imaging and is much more effective than conventional digital mammography. Additionally, our case indicates that precise correlation of CESM with ultrasonography findings contributes to the diagnosis of EICs. This rare case with multiple imaging findings will increase the awareness of EICs in the breast parenchyma.
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Affiliation(s)
- Yongxia Zhang
- Department of Medical Imaging, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P R China.,Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, P R China
| | - Lei Song
- Department of Geratology, Yantai Yuhuangding Hospital, Yantai, Shandong, P R China
| | - Han Zhang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, P R China
| | - Fengjie Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, P R China
| | - Guo Hao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, P R China
| | - Jing Liu
- Department of Pathology, Yantai Yuhuangding Hospital, Yantai, Shandong, P R China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, P R China
| | - Hao Shi
- Department of Medical Imaging, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P R China
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Song J, Zheng Y, Zakir Ullah M, Wang J, Jiang Y, Xu C, Zou Z, Ding G. Multiview multimodal network for breast cancer diagnosis in contrast-enhanced spectral mammography images. Int J Comput Assist Radiol Surg 2021; 16:979-988. [PMID: 33966155 DOI: 10.1007/s11548-021-02391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE CESM (contrast-enhanced spectral mammography) is an efficient tool for detecting breast cancer because of its image characteristics. However, among most deep learning-based methods for breast cancer classification, few models can integrate both its multiview and multimodal features. To effectively utilize the image features of CESM and thus help physicians to improve the accuracy of diagnosis, we propose a multiview multimodal network (MVMM-Net). METHODS The experiment is carried out to evaluate the in-house CESM images dataset taken from 95 patients aged 21-74 years with 760 images. The framework consists of three main stages: the input of the model, image feature extraction, and image classification. The first stage is to preprocess the CESM to utilize its multiview and multimodal features effectively. In the feature extraction stage, a deep learning-based network is used to extract CESM images features. The last stage is to integrate different features for classification using the MVMM-Net model. RESULTS According to the experimental results, the proposed method based on the Res2Net50 framework achieves an accuracy of 96.591%, sensitivity of 96.396%, specificity of 96.350%, precision of 96.833%, F1_score of 0.966, and AUC of 0.966 on the test set. Comparative experiments illustrate that the classification performance of the model can be improved by using multiview multimodal features. CONCLUSION We proposed a deep learning classification model that combines multiple features of CESM. The results of the experiment indicate that our method is more precise than the state-of-the-art methods and produces accurate results for the classification of CESM images.
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Affiliation(s)
- Jingqi Song
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Yuanjie Zheng
- School of Information Science and Engineering, Shandong Normal University, Jinan, China.
| | - Muhammad Zakir Ullah
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Junxia Wang
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Yanyun Jiang
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Chenxi Xu
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Zhenxing Zou
- Medical Imaging Department, Yantai Yuhuangding Hospital, Yantai, China
| | - Guocheng Ding
- Medical Imaging Department, Yantai Yuhuangding Hospital, Yantai, China
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Sistermanns M, Kowall B, Hörnig M, Beiderwellen K, Uhlenbrock D. Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography - A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality. ROFO-FORTSCHR RONTG 2021; 193:1183-1188. [PMID: 33735930 DOI: 10.1055/a-1388-7712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The technically caused delay between low-energy (LE) and high-energy (HE) acquisitions allows motion artifacts in contrast-enhanced dual-energy mammography (CEDEM). In this study the effect of motion correction by nonrigid registration on image quality of the recombined images was investigated. MATERIALS AND METHODS Retrospectively for 354 recombined CEDEM images an additional recombined image was processed from the raw data of LE and HE images using the motion correction algorithm. Five radiologists with many years of experience in breast cancer diagnostic imaging compared side-by-side one conventional processed CEDEM image with the corresponding image processed by the motion correction algorithm. Every pair of images was compared based on six criteria: General image quality (1), sharpness of skin contour (2), reduction of image artifacts (3), sharpness of lesion contour (4), contrast of lesion (5), visibility of lymph nodes (6). These criteria were rated on a Likert scale (improvement: + 1, + 2; deterioration: -1, -2). RESULTS The mean ratings concerning criteria 1-5 showed a superiority of the recombined images processed by the motion correction algorithm. For example, the mean rating of general image quality was 0.86 (95 % CI: 0.78; 0.93). Only the mean rating concerning criterion 6 showed an inferiority of the recombined images processed by the motion correction algorithm (-0.29 (-0.46; -0.13)). CONCLUSION The usage of nonrigid registration for motion correction significantly improves the general image quality and the quality of subordinate criteria on the recombined CEDEM images at the expense of somewhat reduced lymph node visibility in some cases. KEY POINTS · The usage of motion correction in CEDEM improves the general image quality. · Motion correction might have the potential to increase diagnostic accuracy. · Alternative methods of motion artifact reduction are not yet available in clinical practice. CITATION FORMAT · Sistermanns M, Kowall B, Hörnig M et al. Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography - A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality. Fortschr Röntgenstr 2021; 193: 1183 - 1188.
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Affiliation(s)
- Markus Sistermanns
- Department of Radiology, MVZ Prof. Dr. Uhlenbrock & Partner, Dortmund, Germany
| | - Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Germany
| | - Mathias Hörnig
- Department of Diagnostic imaging, X-ray Products, X-ray Physics & Systems, Siemens Healthcare GmbH Forchheim, Germany
| | | | - Detlev Uhlenbrock
- Department of Radiology, MVZ Prof. Dr. Uhlenbrock & Partner, Dortmund, Germany
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15
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Sudhir R, Koppula V, Mandava A, Kamala S, Potlapalli A. Technique and clinical applications of dual-energy contrast-enhanced digital mammography (CEDM) in breast cancer evaluation: a pictorial essay. ACTA ACUST UNITED AC 2020; 27:28-36. [PMID: 33252334 DOI: 10.5152/dir.2020.19573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This pictorial essay illustrates an overview of the basic technique used in acquiring dual-energy contrast-enhanced digital mammography (CEDM) images and its potential clinical applications in regular practice. CEDM may be used as a low-cost alternative to magnetic resonance imaging (MRI), as a problem-solving tool in clinical practice and for therapeutic planning of breast cancer, which may include high-risk screening, dense breast evaluation, mammographically equivocal lesions, local staging, treatment response evaluation, and post treatment follow-up. We share our experience of CEDM at a tertiary care cancer hospital.
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Affiliation(s)
- Rashmi Sudhir
- Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Veeraiah Koppula
- Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Anitha Mandava
- Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Sannapareddy Kamala
- Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Alekya Potlapalli
- Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
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16
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The new method, the old problem - role of contrast-enhanced spectral mammography in the diagnosis of breast cancer among Polish women. Pol J Radiol 2020; 85:e381-e386. [PMID: 32817772 PMCID: PMC7425219 DOI: 10.5114/pjr.2020.97941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose The aim of the study was to evaluate spectral mammography (CESM) in diagnosing breast cancer, which is based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Material and methods The study included a group of 547 women who underwent spectral mammography and histopathological verification of the lesion, previously seen in mammography and/or ultrasound. In the group of 547 women, 593 focal lesions were diagnosed. All CESM examinations were carried-out with a digital mammography device dedicated to performing dual-energy CESM acquisitions. An intravenous injection of 1.5 ml/kg of body mass of non-ionic contrast agent was performed. Results The analysis includes 593 breast lesions, in this group cancer was detected in 327 (55.14%) lesions, and in 256 (43.17%) cases benign lesions were confirmed by histopathological examination and at least 12 months of observation. The method shows differentiation of benign and malignant lesions in the breast: sensitivity of 97.86%, specificity of 59.4%, PPV – 74.76%, NPV – 95.76%. Conclusions Spectral mammography could be an ideal method to detect breast cancer. Thanks to the high NPV (95.76%), it facilitates the exclusion of cancer in situations where pathological contrast enhancement is not observed. The unsatisfactory specificity of the study (59.4%) would not make it safe to avoid a core needle biopsy of lesions that undergo contrast enhancement.
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17
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Kulpe S, Dierolf M, Braig EM, Günther B, Achterhold K, Gleich B, Herzen J, Rummeny E, Pfeiffer F, Pfeiffer D. K-edge subtraction imaging for iodine and calcium separation at a compact synchrotron x-ray source. J Med Imaging (Bellingham) 2020; 7:023504. [PMID: 32341936 DOI: 10.1117/1.jmi.7.2.023504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: About one third of all deaths worldwide can be traced to some form of cardiovascular disease. The gold standard for the diagnosis and interventional treatment of blood vessels is digital subtraction angiography (DSA). An alternative to DSA is K-edge subtraction (KES) imaging, which has been shown to be advantageous for moving organs and for eliminating image artifacts caused by patient movement. As highly brilliant, monochromatic x-rays are required for this method, it has been limited to synchrotron facilities so far, restraining the applicability in the clinical routine. Over the past decades, compact synchrotron x-ray sources based on inverse Compton scattering have been evolving; these provide x-rays with sufficient brilliance and meet spatial and financial requirements for laboratory settings or university hospitals. Approach: We demonstrate a proof-of-principle KES imaging experiment using the Munich Compact Light Source (MuCLS), the first user-dedicated installation of a compact synchrotron x-ray source worldwide. A series of experiments were performed both on a phantom and an excised human carotid to demonstrate the ability of the proposed KES technique to separate the iodine contrast agent and calcifications. Results: It is shown that the proposed filter-based KES method allows for the iodine-contrast agent and calcium to be clearly separated, thereby providing x-ray images only showing one of the two materials. Conclusions: The results show that the quasimonochromatic spectrum of the MuCLS enables filter-based KES imaging and can become an important tool in preclinical research and possible future clinical diagnostics.
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Affiliation(s)
- Stephanie Kulpe
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Martin Dierolf
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Eva-Maria Braig
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Benedikt Günther
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Klaus Achterhold
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Bernhard Gleich
- Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Julia Herzen
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Ernst Rummeny
- Munich School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Franz Pfeiffer
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany.,Munich School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Daniela Pfeiffer
- Munich School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
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Bicchierai G, Tonelli P, Piacenti A, De Benedetto D, Boeri C, Vanzi E, Bianchi S, Cirone D, Kaur Gill M, Miele V, Nori J. Evaluation of contrast‐enhanced digital mammography (CEDM) in the preoperative staging of breast cancer: Large‐scale single‐center experience. Breast J 2020; 26:1276-1283. [DOI: 10.1111/tbj.13766] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/04/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Paolina Tonelli
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Alba Piacenti
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy University of Florence Florence Italy
| | - Donatello Cirone
- General Management Staff Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Maninderpal Kaur Gill
- Department of Biomedical Imaging Kuala Lumpur General Hospital Kuala Lumpur Malaysia
| | - Vittorio Miele
- Emergency Radiology Department Azienda Ospedaliero‐Universitaria Careggi Florence Florence Italy
| | - Jacopo Nori
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
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19
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Cozzi A, Schiaffino S, Sardanelli F. The emerging role of contrast-enhanced mammography. Quant Imaging Med Surg 2019; 9:2012-2018. [PMID: 31929976 DOI: 10.21037/qims.2019.11.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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20
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Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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The feasibility of contrast-enhanced spectral mammography immediately after contrast-enhanced CT. Radiol Phys Technol 2019; 12:277-282. [PMID: 31165975 DOI: 10.1007/s12194-019-00518-6] [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: 12/22/2018] [Revised: 05/29/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
Contrast-enhanced spectral mammography (CESM) is a digital mammography method that requires an intravenous injection of iodinated contrast material to detect hypervascular lesions. In patients undergoing evaluation for metastases before breast tumor surgery, a contrast material must be injected for computed tomography (CT) and CESM studies. The purpose of our study was to investigate the feasibility of performing CESM immediately after contrast-enhanced CT, without injecting additional contrast material. We enrolled 77 women with 88 breast carcinomas. Immediately after contrast-enhanced CT, we performed CESM without injecting additional contrast material. The patients were divided into two groups based on the length of the interval between contrast material injection and the start of mammography. In group A (n = 51), it was less, and in group B (n = 26) it was more than 7 min. We measured the tumor gland contrast of each tumor on the CESM images and recorded the tumor opacification on a 4-point visual scale. The mean interval between the start of contrast material injection for CT and the acquisition of mammograms in groups A and B was 5.41 and 10.40 min, respectively. All lesions were detectable on the CESM images. There was no significant difference in the visual evaluation between the two groups (p = 0.21). CESM immediately after contrast-enhanced CT without the injection of additional contrast material is feasible and cost-effective.
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22
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Correlation between quantitative assessment of contrast enhancement in contrast-enhanced spectral mammography (CESM) and histopathology-preliminary results. Eur Radiol 2019; 29:6220-6226. [PMID: 31089850 PMCID: PMC6795639 DOI: 10.1007/s00330-019-06232-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
Objectives Contrast-enhanced spectral mammography (CESM) is a novel method for breast cancer detection. The aim of this study is to check if there is a possibility of quantitative assessment of contrast enhancement in CESM and if there is any correlation between quantitative assessment of contrast enhancement in CESM and histopathology. Methods A total of 167 female patients underwent CESM. All subjects previously had suspicious lesions found on mammography, breast ultrasound, or both. After imaging, the following parameters were evaluated: number of enhancing lesions in each breast and size and degree of enhancement of each lesion. Based on the collected data, the percentage signal difference between enhancing lesion and background (%RS) and signal-difference-to-noise ratio (SDNR) were measured for each lesion. Results The number of lesions detected in the study population was 195. Among all diagnosed lesions, 120 (62%) were assessed to be infiltrating cancers, 16 (8%) non-infiltrating cancers, and 59 (30%) were benign. Thirteen (7%) lesions did not enhance in CESM; all non-enhancing lesions were confirmed to be benign under histopathological examination. Analysis of enhancement indices showed that signal values within lesions and signal values within background ROIs (regions of interest) were similar in CC (craniocaudal) and MLO (mediolateral) projections. Mean %RS values were correlated with the type of enhancing lesion, infiltrating cancers having the highest values, benign lesions the lowest. Conclusions This work has demonstrated a significant correlation between the degree of lesion enhancement in CESM and malignancy. Quantitative analysis of enhancement levels in CESM can distinguish between invasive cancers and benign or in situ lesions. Key Points • There is a possibility of quantitative assessment of contrast enhancement in CESM. • Correlation between quantitative assessment of contrast enhancement in CESM and histopathology was observed.
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23
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Kulpe S, Dierolf M, Braig E, Günther B, Achterhold K, Gleich B, Herzen J, Rummeny E, Pfeiffer F, Pfeiffer D. K-edge subtraction imaging for coronary angiography with a compact synchrotron X-ray source. PLoS One 2018; 13:e0208446. [PMID: 30532277 PMCID: PMC6287837 DOI: 10.1371/journal.pone.0208446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
About one third of all deaths worldwide can be traced back to cardiovascular diseases. An interventional radiology procedure for their diagnosis is Digital Subtraction Angiography (DSA). An alternative to DSA is K-Edge subtraction (KES) imaging, which has been shown to be advantageous for moving organs and eliminating image artifacts caused by patient movement. As highly brilliant, monochromatic X-rays are required for this method, it has been limited to synchrotron facilities so far, restraining the feasibility in clinical routine. Compact synchrotron X-ray sources based on inverse Compton scattering, which have been evolving substantially over the past decade, provide X-rays with sufficient brilliance that meet spatial and financial requirements affordable in laboratory settings or for university hospitals. In this work, we demonstrate a first proof-of-principle K-edge subtraction imaging experiment using the Munich Compact Light Source (MuCLS), the first user-dedicated installation of a compact synchrotron X-ray source worldwide. It is shown experimentally that the technique of KES increases the visibility of small blood vessels overlaid by bone structures.
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Affiliation(s)
- Stephanie Kulpe
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Eva Braig
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Ivanov D, Bliznakova K, Buliev I, Popov P, Mettivier G, Russo P, Di Lillo F, Sarno A, Vignero J, Bosmans H, Bravin A, Bliznakov Z. Suitability of low density materials for 3D printing of physical breast phantoms. ACTA ACUST UNITED AC 2018; 63:175020. [DOI: 10.1088/1361-6560/aad315] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Savaridas S, Taylor D, Gunawardana D, Phillips M. Could parenchymal enhancement on contrast-enhanced spectral mammography (CESM) represent a new breast cancer risk factor? Correlation with known radiology risk factors. Clin Radiol 2017; 72:1085.e1-1085.e9. [DOI: 10.1016/j.crad.2017.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
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26
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Iotti V, Ravaioli S, Vacondio R, Coriani C, Caffarri S, Sghedoni R, Nitrosi A, Ragazzi M, Gasparini E, Masini C, Bisagni G, Falco G, Ferrari G, Braglia L, Del Prato A, Malavolti I, Ginocchi V, Pattacini P. Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging. Breast Cancer Res 2017; 19:106. [PMID: 28893303 PMCID: PMC5594558 DOI: 10.1186/s13058-017-0899-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neoadjuvant-chemotherapy (NAC) is considered the standard treatment for locally advanced breast carcinomas. Accurate assessment of disease response is fundamental to increase the chances of successful breast-conserving surgery and to avoid local recurrence. The purpose of this study was to compare contrast-enhanced spectral mammography (CESM) and contrast-enhanced-MRI (MRI) in the evaluation of tumor response to NAC. METHODS This prospective study was approved by the institutional review board and written informed consent was obtained. Fifty-four consenting women with breast cancer and indication of NAC were consecutively enrolled between October 2012 and December 2014. Patients underwent both CESM and MRI before, during and after NAC. MRI was performed first, followed by CESM within 3 days. Response to therapy was evaluated for each patient, comparing the size of the residual lesion measured on CESM and MRI performed after NAC to the pathological response on surgical specimens (gold standard), independently of and blinded to the results of the other test. The agreement between measurements was evaluated using Lin's coefficient. The agreement between measurements using CESM and MRI was tested at each step of the study, before, during and after NAC. And last of all, the variation in the largest dimension of the tumor on CESM and MRI was assessed according to the parameters set in RECIST 1.1 criteria, focusing on pathological complete response (pCR). RESULTS A total of 46 patients (85%) completed the study. CESM predicted pCR better than MRI (Lin's coefficient 0.81 and 0.59, respectively). Both methods tend to underestimate the real extent of residual tumor (mean 4.1mm in CESM, 7.5mm in MRI). The agreement between measurements using CESM and MRI was 0.96, 0.94 and 0.76 before, during and after NAC respectively. The distinction between responders and non-responders with CESM and MRI was identical for 45/46 patients. In the assessment of CR, sensitivity and specificity were 100% and 84%, respectively, for CESM, and 87% and 60% for MRI. CONCLUSION CESM and MRI lesion size measurements were highly correlated. CESM seems at least as reliable as MRI in assessing the response to NAC, and may be an alternative if MRI is contraindicated or its availability is limited.
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Affiliation(s)
- Valentina Iotti
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy.
| | - Sara Ravaioli
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Rita Vacondio
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Chiara Coriani
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Sabrina Caffarri
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL Reggio Emilia, via Amendola 2, Reggio Emilia, 42122, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Andrea Nitrosi
- Medical Physics Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Moira Ragazzi
- Pathology Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Elisa Gasparini
- Oncology Unit, Hospital C. Magati, AUSL Reggio Emilia, Via Martiri della Libertà, No. 8, Scandiano (RE), 42019, Italy
| | - Cristina Masini
- Oncology Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Giancarlo Bisagni
- Oncology Unit, Department of Oncology and Advanced Technologies, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Giuseppe Falco
- Breast Surgery Unit, Department of Surgery, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Guglielmo Ferrari
- Breast Surgery Unit, Department of Surgery, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Luca Braglia
- Scientific Directorate, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Alberto Del Prato
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
| | - Ivana Malavolti
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL Reggio Emilia, via Amendola 2, Reggio Emilia, 42122, Italy
| | - Vladimiro Ginocchi
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL Reggio Emilia, via Amendola 2, Reggio Emilia, 42122, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Arcispedale Santa Maria Nuova - IRCCS, Viale Umberto I, No. 50, 42123, Reggio Emilia, Italy
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Baneva Y, Bliznakova K, Cockmartin L, Marinov S, Buliev I, Mettivier G, Bosmans H, Russo P, Marshall N, Bliznakov Z. Evaluation of a breast software model for 2D and 3D X-ray imaging studies of the breast. Phys Med 2017; 41:78-86. [DOI: 10.1016/j.ejmp.2017.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/31/2017] [Accepted: 04/22/2017] [Indexed: 12/01/2022] Open
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Ding H, Molloi S. Quantitative contrast-enhanced spectral mammography based on photon-counting detectors: A feasibility study. Med Phys 2017; 44:3939-3951. [PMID: 28432828 DOI: 10.1002/mp.12296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To investigate the feasibility of accurate quantification of iodine mass thickness in contrast-enhanced spectral mammography. MATERIALS AND METHODS A computer simulation model was developed to evaluate the performance of a photon-counting spectral mammography system in the application of contrast-enhanced spectral mammography. A figure-of-merit (FOM), which was defined as the decomposed iodine signal-to-noise ratio (SNR) with respect to the square root of the mean glandular dose (MGD), was chosen to optimize the imaging parameters, in terms of beam energy, splitting energy, and prefiltrations for breasts of various thicknesses and densities. Experimental phantom studies were also performed using a beam energy of 40 kVp and a splitting energy of 34 keV with 3 mm Al prefiltration. A two-step calibration method was investigated to quantify the iodine mass thickness, and was validated using phantoms composed of a mixture of glandular and adipose materials, for various breast thicknesses and densities. Finally, the traditional dual-energy log-weighted subtraction method was also studied as a comparison. The measured iodine signal from both methods was compared to the known value to characterize the quantification accuracy and precision. RESULTS The optimal imaging parameters, which lead to the highest FOM, were found at a beam energy between 42 and 46 kVp with a splitting energy at 34 keV. The optimal tube voltage decreased as the breast thickness or the Al prefiltration increased. The proposed quantification method was able to measure iodine mass thickness on phantoms of various thicknesses and densities with high accuracy. The root-mean-square (RMS) error for cm-scale lesion phantoms was estimated to be 0.20 mg/cm2 . The precision of the technique, characterized by the standard deviation of the measurements, was estimated to be 0.18 mg/cm2 . The traditional weighted subtraction method also predicted a linear correlation between the measured signal and the known iodine mass thickness. However, the correlation slope and offset values were strongly dependent on the total breast thickness and density. CONCLUSION The results of this study suggest that iodine mass thickness for cm-scale lesions can be accurately quantified with contrast-enhanced spectral mammography. The quantitative information can potentially improve the differential power for malignancy.
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Affiliation(s)
- Huanjun Ding
- Department of Radiological Sciences, University of California, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California, Irvine, CA, 92697, USA
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Bhimani C, Matta D, Roth RG, Liao L, Tinney E, Brill K, Germaine P. Contrast-enhanced Spectral Mammography: Technique, Indications, and Clinical Applications. Acad Radiol 2017; 24:84-88. [PMID: 27773458 DOI: 10.1016/j.acra.2016.08.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced spectral mammography (CESM) combines the benefits of full field digital mammography with the concept of tumor angiogenesis. Technique and practical applications of CESM are discussed. MATERIALS AND METHODS An overview of the technique is followed by a demonstration of practical applications of CESM in our practice. RESULTS We have successfully implemented CESM into our practice as a screening, diagnostic, staging, and treatment response tool. CONCLUSION It is important to understand the technique of CESM and how to incorporate it into practice.
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Bhimani C, Li L, Liao L, Roth RG, Tinney E, Germaine P. Contrast-enhanced Spectral Mammography: Modality-Specific Artifacts and Other Factors Which May Interfere with Image Quality. Acad Radiol 2017; 24:89-94. [PMID: 27765597 DOI: 10.1016/j.acra.2016.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Contrast-enhanced spectral mammography (CESM) uses full field digital mammography with the added benefit of intravenous contrast administration to significantly reduce false-positive and false-negative results and improve specificity while maintaining high sensitivity. For CESM to fulfill its purpose, one should be aware of possible artifacts and other factors which may interfere with image quality, and attention should be taken to minimize these factors. MATERIALS AND METHODS This pictorial demonstration will depict types of artifacts detected and other factors that interfere with image acquisition in our practice since CESM implementation. RESULTS Many of the artifacts and other factors we have encountered while using CESM have simple solutions to resolve them. CONCLUSION The illustrated artifacts and other factors interfering with image quality will serve as a useful reference to anyone using CESM.
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Łuczyńska E, Niemiec J, Hendrick E, Heinze S, Jaszczyński J, Jakubowicz J, Sas-Korczyńska B, Rys J. Degree of Enhancement on Contrast Enhanced Spectral Mammography (CESM) and Lesion Type on Mammography (MG): Comparison Based on Histological Results. Med Sci Monit 2016; 22:3886-3893. [PMID: 27768681 PMCID: PMC5077289 DOI: 10.12659/msm.900371] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Contrast enhanced spectral mammography (CESM) is a new method of breast cancer diagnosis in which an iodinated contrast agent is injected and dual-energy mammography is obtained in multiple views of the breasts. The aim of this study was to compare the degree of enhancement on CESM with lesion characteristics on mammography (MG) and lesion histology in women with suspicious breast lesions. Material/Methods The degree of enhancement on CESM (absent, weak, medium, or strong) was compared to lesion characteristics on MG (mass, mass with microcalcifications, or microcalcifications alone) and histology (infiltrating carcinoma, intraductal carcinoma, or benign) to compare sensitivity of the two modalities and to establish correlations that might improve diagnostic accuracy. Results Among 225 lesions identified with CESM and MG, histological evaluation revealed 143 carcinomas (127 infiltrating, 16 intraductal) and 82 benign lesions. This is the largest cohort investigated with CESM to date. The sensitivity of CESM was higher than that of MG (100% and 90%, respectively, p=0.010). Medium or strong enhancement on CESM and the presence of a mass on MG was the most likely indictor of malignancy (55.1% p=0.002). Among benign lesions, 60% presented as enhancement on CESM (were false-positive), and most frequently as medium or weak enhancement, together with a mass on MG (53%, p=0.047). Unfortunately, the study did not find combinations of MG findings and CESM enhancement patterns that would be helpful in defining false-positive lesions. We observed systematic overestimation of maximum lesion diameter on CESM compared to histology (mean difference: 2.29 mm). Conclusions Strong or medium enhancement on CESM and mass or mass with microcalcifications on MG were strong indicators of malignant transformation. However, we found no combination of MG and CESM characteristics helpful in defining false-positive lesions.
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Affiliation(s)
- Elżbieta Łuczyńska
- Department of Radiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Joanna Niemiec
- Department of Applied Radiobiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Edward Hendrick
- Department of Radiology, School of Medicine, University of Colorado, Denver, Aurora, CO, USA
| | - Sylwia Heinze
- Department of Radiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Janusz Jaszczyński
- Department of Urology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Jerzy Jakubowicz
- Oncology Clinic and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Beata Sas-Korczyńska
- Oncology Clinic and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
| | - Janusz Rys
- Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Cracow Branch, Cracow, Poland
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Wang Q, Li K, Wang L, Zhang J, Zhou Z, Feng Y. Preclinical study of diagnostic performances of contrast-enhanced spectral mammography versus MRI for breast diseases in China. SPRINGERPLUS 2016; 5:763. [PMID: 27386249 PMCID: PMC4912545 DOI: 10.1186/s40064-016-2385-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Abstract
Purpose To evaluate diagnostic performances of CESM for breast diseases with comparison to breast MRI in China. Materials and methods Sixty-eight patients with 77 breast lesions underwent MR and CESM. Two radiologists interpreted either MRI or CESM images, separately and independently. BI-RADS 1–3 and BI-RADS 4–5 were classified into the suspicious benign and suspicious malignant groups. Diagnostic accuracy parameters were calculated. Receiver operating characteristic (ROC) curves were constructed for the two modalities. The agreement and correlation between maximum lesion diameter based on CESM and MRI, or CESM and pathology were analyzed. Results Diagnostic accuracy parameters for CESM were sensitivity 95.8 %, specificity 65.5 %, PPV 82.1 %, NPV 90.5 % and accuracy 84.4 %. The diagnostic accuracy parameters for breast MRI were sensitivity 93.8 %, specificity 82.8 %, PPV 88.2 %, NPV 92.3 %and accuracy 89.6 %. Area under the curve (AUC) of ROC was 0.96 for breast MRI and 0.88 for CESM. The Bland–Altman plots showed a mean difference of 0.7 mm with 95 % limits of agreement of 11.4 mm in tumor diameter measured using CESM and breast MRI. The differences of size measurement between CESM and breast MRI were significant, whereas no difference was observed between CESM and pathology as well as between breast MRI and pathology. The better correlation with pathological results was found in CESM than breast MRI. Conclusion Our study demonstrates that CESM possesses better diagnostic performances than breast MRI in terms of diagnostic sensitivity and lesion size assessment. And CESM is a good alternative method of screening breast cancer in high-risk people.
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Affiliation(s)
- Qingguo Wang
- Department of Radiology, Shanghai First People's Hospital, No 100, Haining Road, Hongkou District, Shanghai, China
| | - Kangan Li
- Department of Radiology, Shanghai First People's Hospital, No 100, Haining Road, Hongkou District, Shanghai, China
| | - Lihui Wang
- Department of Radiology, Shanghai First People's Hospital, No 100, Haining Road, Hongkou District, Shanghai, China
| | - Jianbing Zhang
- Department of Pathology, Shanghai First People's Hospital, Shanghai, China
| | - Zhiguo Zhou
- Department of Radiology, Shanghai First People's Hospital, No 100, Haining Road, Hongkou District, Shanghai, China
| | - Yan Feng
- Department of Radiology, Shanghai First People's Hospital, No 100, Haining Road, Hongkou District, Shanghai, China
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Diagnostic performance of contrast-enhanced spectral mammography: Systematic review and meta-analysis. Breast 2016; 28:13-9. [PMID: 27161411 DOI: 10.1016/j.breast.2016.04.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/31/2016] [Accepted: 04/15/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To estimate sensitivity and specificity of CESM for breast cancer diagnosis. METHODS Systematic review and meta-analysis of the accuracy of CESM in finding breast cancer in highly selected women. We estimated summary receiver operating characteristic curves, sensitivity and specificity according to quality criteria with QUADAS-2. RESULTS Six hundred four studies were retrieved, 8 of these reporting on 920 patients with 994 lesions, were eligible for inclusion. Estimated sensitivity from all studies was: 0.98 (95% CI: 0.96-1.00). Specificity was estimated from six studies reporting raw data: 0.58 (95% CI: 0.38-0.77). The majority of studies were scored as at high risk of bias due to the very selected populations. CONCLUSION CESM has a high sensitivity but very low specificity. The source studies were based on highly selected case series and prone to selection bias. High-quality studies are required to assess the accuracy of CESM in unselected cases.
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Lobbes M, Houben I. Contrast-enhanced tomosynthesis: The best of both worlds or more of the same? Eur J Radiol 2016; 85:507-8. [DOI: 10.1016/j.ejrad.2015.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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