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McDonald ES, Scheel JR, Lewin AA, Weinstein SP, Dodelzon K, Dogan BE, Fitzpatrick A, Kuzmiak CM, Newell MS, Paulis LV, Pilewskie M, Salkowski LR, Silva HC, Sharpe RE, Specht JM, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024; 21:S168-S202. [PMID: 38823943 DOI: 10.1016/j.jacr.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Elizabeth S McDonald
- Research Author, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Scheel
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Basak E Dogan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Fitzpatrick
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | | | - Melissa Pilewskie
- University of Michigan, Ann Arbor, Michigan; Society of Surgical Oncology
| | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - H Colleen Silva
- The University of Texas Medical Branch, Galveston, Texas; American College of Surgeons
| | | | - Jennifer M Specht
- University of Washington, Seattle, Washington; American Society of Clinical Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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Miller MM, Mayorov S, Ganti R, Nguyen JV, Rochman CM, Caley M, Jahjah J, Repich K, Patrie JT, Anderson RT, Harvey JA, Rooney TB. Patient Experience of Women With Dense Breasts Undergoing Screening Contrast-Enhanced Mammography. JOURNAL OF BREAST IMAGING 2024; 6:277-287. [PMID: 38537570 DOI: 10.1093/jbi/wbae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 05/28/2024]
Abstract
OBJECTIVE We investigated patient experience with screening contrast-enhanced mammography (CEM) to determine whether a general population of women with dense breasts would accept CEM in a screening setting. METHODS In this institutional review board-approved prospective study, patients with heterogeneous and extremely dense breasts on their mammogram were invited to undergo screening CEM and complete pre-CEM and post-CEM surveys. On the pre-CEM survey, patients were asked about their attitudes regarding supplemental screening in general. On the post-CEM survey, patients were asked about their experience undergoing screening CEM, including causes and severity of any discomfort and whether they would consider undergoing screening CEM again in the future or recommend it to a friend. RESULTS One hundred sixty-three women were surveyed before and after screening CEM. Most patients, 97.5% (159/163), reported minimal or no unpleasantness associated with undergoing screening CEM. In addition, 91.4% (149/163) said they would probably or very likely undergo screening CEM in the future if it cost the same as a traditional screening mammogram, and 95.1% (155/163) said they would probably or very likely recommend screening CEM to a friend. Patients in this study, who were all willing to undergo CEM, more frequently reported a family history of breast cancer than a comparison cohort of women with dense breasts (58.2% vs 47.1%, P = .027). CONCLUSION Patients from a general population of women with dense breasts reported a positive experience undergoing screening CEM, suggesting screening CEM might be well received by this patient population, particularly if the cost was comparable with traditional screening mammography.
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Affiliation(s)
- Matthew M Miller
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Shanna Mayorov
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ramapriya Ganti
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Jonathan V Nguyen
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Carrie M Rochman
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Matthew Caley
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Jessie Jahjah
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Kathy Repich
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Jennifer A Harvey
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy B Rooney
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
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Day JA, Tanguay J. Monte-Carlo study of contrast-enhanced spectral mammography with cadmium telluride photon-counting x-ray detectors. Med Phys 2024; 51:2479-2498. [PMID: 37967277 DOI: 10.1002/mp.16837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/09/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Contrast-enhanced spectral mammography (CESM) with photon-counting x-ray detectors (PCDs) can be used to improve the classification of breast cancers as benign or malignant. Commercially-available PCD-based mammography systems use silicon-based PCDs. Cadmium-telluride (CdTe) PCDs may provide a practical advantage over silicon-based PCDs because they can be implemented as large-area detectors that are more easily adaptable to existing mammography systems. PURPOSE The purpose of this work is to optimize CESM implemented with CdTe PCDs and to investigate the influence of the number of energy bins, electronic noise level, pixel size, and anode material on image quality. METHODS We developed a Monte Carlo model of the energy-bin-dependent modulation transfer functions (MTFs) and noise power spectra, including spatioenergetic noise correlations. We validated model predictions using a CdTe PCD with analog charge summing for charge-sharing suppression. Using the ideal-observer detectability, we optimized CESM for the task of detecting a 7-mm-diameter iodine nodule embedded in a breast with 50% glandularity. We optimized the tube voltage, beam filtration, and the location of energy thresholds for 50 and 100- μ $\mu$ m pixels, tungsten and molybdenum anodes, and two electronic noise levels. One of the electronic noise levels was that of the experimental system; the other was half that of the experimental system. Optimization was performed for CdTe PCDs with two or three energy bins. We also estimated the impact of anatomic noise due to background parenchymal enhancement and computed the minimum detectable iodine area density in the presence of quantum and anatomic noise. RESULTS Model predictions of the MTFs and noise power spectra agreed well with experiment. For optimized systems, adding a third energy bin increased quantum noise levels and reduced detectability by ∼55% compared to two-bin approaches that simply suppress contrast between fibroglandular and adipose tissue. Decreasing the electronic noise standard deviation from 3.4 to 1.7 keV increased iodine detectability by ∼5% and ∼30% for two-bin imaging and three-bin imaging, respectively. After optimizing for tube voltage, beam filtration, and the location of energy thresholds, there was ∼a 3% difference in iodine detectability between molybdenum and tungsten anodes for two-bin imaging, but for three-bin imaging, molybdenum anodes provided up to 14% increase in detectability relative to tungsten anodes. Anatomic noise decreased iodine detectability by 15% to 40%, with greater impact for lower electronic noise settings and larger pixel sizes. CONCLUSIONS For CESM implemented with CdTe PCDs, (1) quantitatively-accurate three-material decompositions using three energy bins are associated with substantial increases in quantum noise relative to two-energy-bin approaches that simply suppress contrast between fibroglandular and adipose tissues; (2) tungsten and molybdenum anodes can provide nearly equal iodine detectability for two-bin imaging, but molybdenum provides a modest detectability advantage for three-bin imaging provided that all other technique parameters are optimized; (3) reducing pixel sizes from 100 to 50 μ $\mu$ m can reduce detectability by up to 20% due to charge sharing; (4) anatomic noise due to background parenchymal enhancement is estimated to have a substantial impact on lesion visibility, reducing detectability by approximately 30%.
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Affiliation(s)
- James A Day
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Jesse Tanguay
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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Fischer U, Diekmann F, Helbich T, Preibsch H, Püsken M, Wenkel E, Wienbeck S, Fallenberg EM. [Use of contrast-enhanced mammography for diagnosis of breast cancer]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:916-924. [PMID: 37889284 PMCID: PMC10692004 DOI: 10.1007/s00117-023-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is an imaging method that is able to improve visualization of intramammary tumors after peripheral venous administration of an iodine-containing contrast medium (ICM). OBJECTIVES AND METHODS The current significance of CEM is discussed. RESULTS Studies were able to show an advantage of CEM in the diagnosis of breast cancer compared to mammography, especially for women with dense breasts. Indications for CEM currently depend on the availability of magnetic resonance imaging (MRI). If MRI is available, CEM is indicated in those cases when MRI cannot be performed. Use of CEM for breast cancer screening is currently viewed critically. This view can change when results and updated assessments of large CEM studies in Europe and USA become available. Patients must be informed about the use of an ICM. As ICM administration for CEM is carried out in a similar manner to established imaging methods, the authors expect the use of ICM for CEM to be unproblematic as long as general contraindications are adhered to. CONCLUSIONS In the future, CEM could have greater importance for the diagnosis of breast cancer, as this imaging method has diagnostic advantages compared to conventional mammography. A great advantage of CEM is its availability. For those who use breast MRI, CEM is helpful when MRI is not feasible due to contraindications or other reasons.
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Affiliation(s)
- Uwe Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen, Deutschland.
| | - Felix Diekmann
- Institut für Radiologische Diagnostik, Krankenhaus St. Joseph-Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Thomas Helbich
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Pädiatrische Radiologie, Medizinische Universität Wien/AKH WIEN, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Heike Preibsch
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Michael Püsken
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Evelyn Wenkel
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Radiologie München, München, Deutschland
| | - Susanne Wienbeck
- Radiologie Schwarzer Bär MVZ, Schwarzer Bär 8, 30449, Hannover, Deutschland
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Eva Maria Fallenberg
- Institut für diagnostische und interventionelle Radiologie, School of Medicine & Klinikum rechts der Isar Technische Universität München (TUM), Ismaninger Str. 22, 81675, München, Deutschland
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Moffa G, Galati F, Maroncelli R, Rizzo V, Cicciarelli F, Pasculli M, Pediconi F. Diagnostic Performance of Contrast-Enhanced Digital Mammography versus Conventional Imaging in Women with Dense Breasts. Diagnostics (Basel) 2023; 13:2520. [PMID: 37568883 PMCID: PMC10416841 DOI: 10.3390/diagnostics13152520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this prospective study was to compare the diagnostic performance of contrast-enhanced mammography (CEM) versus digital mammography (DM) combined with breast ultrasound (BUS) in women with dense breasts. Between March 2021 and February 2022, patients eligible for CEM with the breast composition category ACR BI-RADS c-d at DM and an abnormal finding (BI-RADS 3-4-5) at DM and/or BUS were considered. During CEM, a nonionic iodinated contrast agent (Iohexol 350 mg I/mL, 1.5 mL/kg) was power-injected intravenously. Images were evaluated independently by two breast radiologists. Findings classified as BI-RADS 1-3 were considered benign, while BI-RADS 4-5 were considered malignant. In case of discrepancies, the higher category was considered for DM+BUS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, using histology/≥12-month follow-up as gold standards. In total, 51 patients with 65 breast lesions were included. 59 (90.7%) abnormal findings were detected at DM+BUS, and 65 (100%) at CEM. The inter-reader agreement was excellent (Cohen's k = 0.87 for DM+BUS and 0.97 for CEM). CEM showed a 93.5% sensitivity (vs. 90.3% for DM+BUS), a 79.4-82.4% specificity (vs. 32.4-35.5% for DM+BUS) (McNemar p = 0.006), a 80.6-82.9% PPV (vs. 54.9-56.0% for DM+BUS), a 93.1-93.3% NPV (vs. 78.6-80.0% for DM+BUS), and a 86.1-87.7% accuracy (vs. 60.0-61.5% for DM+BUS). The AUC was higher for CEM than for DM+BUS (0.865 vs. 0.613 for Reader 1, and 0.880 vs. 0.628, for Reader 2) (p < 0.001). In conclusion, CEM had a better diagnostic performance than DM and BUS alone and combined together in patients with dense breasts.
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Affiliation(s)
- Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.G.); (R.M.); (V.R.); (F.C.); (M.P.); (F.P.)
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Daniaux M, Gruber L, De Zordo T, Geiger-Gritsch S, Amort B, Santner W, Egle D, Baltzer PAT. Preoperative staging by multimodal imaging in newly diagnosed breast cancer: Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography, ultrasound, and MRI. Eur J Radiol 2023; 163:110838. [PMID: 37080064 DOI: 10.1016/j.ejrad.2023.110838] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To compare contrast-enhanced spectral mammography (CESM) with mammography (Mx), ultrasound (US), and magnetic resonance imaging (MRI) regarding breast cancer detection rate and preoperative local staging. MATERIAL AND METHODS This prospective observational, single-centre study included 128 female patients (mean age 55.8 ± 11.5 years) with a newly diagnosed malignant breast tumour during routine US and Mx were prospectively enrolled. CESM and MRI examinations were performed within the study. Analysis included interreader agreement, tumour type and grade distribution, detection rates (DR), imaging morphology, contrast-enhancement and was performed by two independent readers blinded to patient history and histopathological diagnosis. Assessment of local disease extent was compared between modalities via Bland-Altman plots. RESULTS One-hundred-and-ten tumours were classified as NST (85.9%), 4 as ILC (3.1%) and 10 as DCIS (7.8%). DR was highest for MRI (128/128, 100.0%), followed by US (124/128, 96.9%) and CESM (123/128, 96.1%) and lowest for conventional Mx (106/128, 82.8%) (p = 0.0002). Higher breast density did not negatively affect DR of US, CESM or MRI. Local tumour extent measurements based on CESM (Bland-Altman bias 6.6, standard deviation 30.2) showed comparable estimation results to MRI, surpassing Mx (23.4/43.7) and US (35.4/40.5). Even though detection of multifocality and multicentricity was highest for CESM and MRI (p < 0.0001), second-look rates, i.e., targeted US examinations after MRI or CESM, were significantly lower for CESM (10.2% of cases) compared to MRI (16.2%) with a significantly higher true positive rate for CESM (72.0%) vs. MRI (42.5%). CONCLUSION CESM is a viable alternative to MRI for lesion detection and local staging in newly diagnosed malignant breast cancer and provides higher specificity in regard to second-look examinations.
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Affiliation(s)
- Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Tobias De Zordo
- Department of Radiology, Brixsana Private Clinic, Julius-Durst-Straße 28, Brixen, Italy
| | - Sabine Geiger-Gritsch
- Medizinisches Projektmanagement, Tirol Kliniken GmbH, Anichstraße 35, Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Wolfram Santner
- Department of Radiology, Privatklinik Hirslanden, Rigistrasse 1, Cham, Switzerland
| | - Daniel Egle
- Department of Gynaecology and Obstetrics, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, Vienna, Austria
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De Jesus C, Moseley TW, Diaz V, Vishwanath V, Jean S, Elhatw A, Ferreira Dalla Pria HR, Chung HL, Guirguis MS, Patel MM. Supplemental Screening for Breast Cancer. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Miller MM, Rubaiyat AHM, Rohde GK. Predicting Malignancy of Breast Imaging Findings Using Quantitative Analysis of Contrast-Enhanced Mammography (CEM). Diagnostics (Basel) 2023; 13:diagnostics13061129. [PMID: 36980437 PMCID: PMC10047016 DOI: 10.3390/diagnostics13061129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
We sought to develop new quantitative approaches to characterize the spatial distribution of mammographic density and contrast enhancement of suspicious contrast-enhanced mammography (CEM) findings to improve malignant vs. benign classifications of breast lesions. We retrospectively analyzed all breast lesions that underwent CEM imaging and tissue sampling at our institution from 2014–2020 in this IRB-approved study. A penalized linear discriminant analysis was used to classify lesions based on the averaged histograms of radial distributions of mammographic density and contrast enhancement. T-tests were used to compare the classification accuracies of density, contrast, and concatenated density and contrast histograms. Logistic regression and AUC-ROC analyses were used to assess if adding demographic and clinical data improved the model accuracy. A total of 159 suspicious findings were evaluated. Density histograms were more accurate in classifying lesions as malignant or benign than a random classifier (62.37% vs. 48%; p < 0.001), but the concatenated density and contrast histograms demonstrated a higher accuracy (71.25%; p < 0.001) than the density histograms alone. Including the demographic and clinical data in our models led to a higher AUC-ROC than concatenated density and contrast images (0.81 vs. 0.70; p < 0.001). In the classification of invasive vs. non-invasive malignancy, the concatenated density and contrast histograms demonstrated no significant improvement in accuracy over the density histograms alone (77.63% vs. 78.59%; p = 0.504). Our findings suggest that quantitative differences in the radial distribution of mammographic density could be used to discriminate malignant from benign breast findings; however, classification accuracy was significantly improved with the addition of contrast-enhanced imaging data from CEM. Adding patient demographic and clinical information further improved the classification accuracy.
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Affiliation(s)
- Matthew M. Miller
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA 22903, USA
- Correspondence:
| | - Abu Hasnat Mohammad Rubaiyat
- Department of Electrical and Computer Engineering, University of Virginia, 415 Lane Rd., Charlottesville, VA 22903, USA
| | - Gustavo K. Rohde
- Department of Biomedical Engineering, University of Virginia, 415 Lane Rd., Charlottesville, VA 22903, USA
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Kandil NMM, Hashem LMB, Gareer SWY, Hashem AMB. Accuracy of different sonomammographic imaging modalities in assessment of breast tumor size. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurate breast cancer size is crucial for staging and an important prognostic factor in patient management. Therapeutic decisions heavily depend on tumor size detection by radiological imaging. The purpose of our prospective comparative study is to compare the diagnostic accuracy of different sonomammographic breast imaging modalities, namely DM, DBT, CESM, 2D US and 3D US in the preoperative tumor size measurement.
Results
CESM, 3D US and 2D US achieved moderately strong correlation with the pathological size measurements, while (DM) and (DBT) showed fair correlation with the pathology. CESM showed the highest correlation coefficient (0.789), while (DBT) showed the lowest correlation coefficient (0.411). Regarding the agreement, there was good agreement of the size measured by CESM, 3D US and 2D US with the pathology as the ICC was (0.798), (0.769) and (0.624), respectively. The highest agreement with the pathology was achieved with CESM. The agreement of the size measured by (DM) and (DBT) with the pathology was moderate as the ICC was (0.439) and (0.416), respectively. The lowest agreement was achieved with the size measured by (DBT).
Conclusions
CESM and 3D US are more superior to DM, 2D US and DBT regarding preoperative size measurement. 3D US can be used as preoperative noninvasive technique, especially in patients with impaired renal function who cannot tolerate CESM.
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Niroshani S, Nakamura T, Michiru N, Negishi T. An approach to dual-energy contrast-enhanced spectral mammography (DE-CESM) using a double layer filter: dosimetric and image quality assessment. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021534. [PMID: 35730431 DOI: 10.1088/1361-6498/ac7aed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Dual-energy contrast-enhanced spectral mammography (DE-CESM) is a recently developed advanced technique in digital mammography that uses an iodinated intravenous contrast agent to assess tumor angiogenesis. The aim of this study was to investigate the diagnostic potential of DE-CESM recombined images in terms of radiation dose and image quality. A 50% fibroglandular-50% adipose, custom-made phantom with iodine inserts of 1.0 mgI cm-3, 2.0 mgI cm-3, 4.0 mgI cm-3was used for the estimation of mean glandular dose (MGD) and the image quality. Low-energy (LE) images were acquired with the W/Rh, W/Rh + 0.01 mm Cu and W/Rh + 0.5 mm Al while high energy images (HE) are acquired with the W/Rh, W/Rh + 0.06 mm Ba, W/Rh + 0.01 mm Cu, and W/Rh + 0.03 mm Ce anode filter combinations. The total MGD was reduced up to a maximum from 1.75 mGy to 1.45 mGy by using Rh + 0.01 mm Cu double-layer filter for both LE and HE imaging of 50 mm, standard 50% fibroglandular phantom compared to Rh single-layer filter with W target. The minimum total MGD reduction (1.69 mGy) was observed when Rh + 0.5 mm Al was used for LE and Rh + 0.06 mm Ba was used for HE exposure. The image quality was comparable with the single-layer filter. The use of W/Rh + 0.01 mm Cu or W/Rh + 0.5 mm Al as target/filter combination for LE exposure and W/Rh + 0.01 mm Cu for HE exposure can reduce the additional radiation dose delivered by DE-CESM without degrading the image quality.
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Affiliation(s)
- Sachila Niroshani
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Tokiko Nakamura
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Department of Radiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Nikaidou Michiru
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Toru Negishi
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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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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Woodard S, Murray A. Contrast-Enhanced Mammography: Reviewing the Past and Looking to the Future. Semin Roentgenol 2021; 57:126-133. [DOI: 10.1053/j.ro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
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Hannsun G, Saponaro S, Sylvan P, Elmi A. Contrast-Enhanced Mammography: Technique, Indications, and Review of Current Literature. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
To provide an update on contrast-enhanced mammography (CEM) regarding current technique and interpretation, the performance of this modality versus conventional breast imaging modalities (mammography, ultrasound, and MRI), existing clinical applications, potential challenges, and pitfalls.
Recent Findings
Multiple studies have shown that the low-energy, non-contrast-enhanced images obtained when performing CEM are non-inferior to full-field digital mammography with the added benefit of recombined post-contrast images, which have been shown to provide comparable information compared to MRI without sacrificing sensitivity and negative predictive values. While CEMs' usefulness for further diagnostic characterization of indeterminate breast findings is apparent, additional studies have provided strong evidence of potential roles in screening intermediate to high-risk populations, evaluation of disease extent, and monitoring response to therapy, particularly in patients in whom MRI is either unavailable or contraindicated. Others have shown that some patients prefer CEM over MRI given the ease of performance and patient comfort. Additionally, some health systems may find significantly reduced costs compared to MRI. Currently, CEM is hindered by the limited availability of CEM-guided tissue sampling and issues of intravenous contrast administration. However, commercially available CEM-guided biopsy systems are on the horizon, and small changes in practice workflow can be quickly adopted. As of now, MRI remains a mainstay of high-risk screening, evaluation of the extent of disease, and monitoring response to therapy, but smaller studies have suggested that CEM may be equivalent to MRI for these indications, and larger confirmatory studies are needed.
Summary
CEM is an emerging problem-solving breast imaging modality that provides complementary information to conventional imaging modalities and may potentially be used in place of MRI for specific indications and/or patient populations.
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15
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Weinstein SP, Slanetz PJ, Lewin AA, Battaglia T, Chagpar AB, Dayaratna S, Dibble EH, Goel MS, Hayward JH, Kubicky CD, Le-Petross HT, Newell MS, Sanford MF, Scheel JR, Vincoff NS, Yao K, Moy L. ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density. J Am Coll Radiol 2021; 18:S456-S473. [PMID: 34794600 DOI: 10.1016/j.jacr.2021.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
Mammography remains the only validated screening tool for breast cancer, however, there are limitations to mammography. One of the limitations of mammography is the variable sensitivity based on breast density. Supplemental screening may be considered based on the patient's risk level and breast density. For average-risk women with nondense breasts, the sensitivity of digital breast tomosynthesis (DBT) screening is high; additional supplemental screening is not warranted in this population. For average-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhanced mammography, screening ultrasound (US), breast MRI, or abbreviated breast MRI. In intermediate-risk women, there is emerging evidence suggesting that women in this population may benefit from breast MRI or abbreviated breast MRI. In intermediate-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhancedmammography or screening US. There is strong evidence supporting screening high-risk women with breast MRI regardless of breast density. Contrast-enhanced mammography, whole breast screening US, or abbreviated breast MRI may be also considered. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Susan P Weinstein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Priscilla J Slanetz
- Panel Chair, Boston University School of Medicine, Boston, Massachusetts; and President, Massachusetts Radiological Society
| | - Alana A Lewin
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Tracy Battaglia
- Director, Womens Health Unit, Associate Director, Belkin Breast Health Center, Boston Medical Center and Boston University School of Medicine and Public Health, Boston, Massachusetts; and Chair, National Navigation Roundtable
| | - Anees B Chagpar
- Yale School of Medicine, New Haven, Connecticut; Society of Surgical Oncology
| | - Sandra Dayaratna
- Thomas Jefferson University Hospital, Robbinsville, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Mita Sanghavi Goel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; American College of Physicians
| | | | | | - Huong T Le-Petross
- The University of Texas MD Anderson Cancer Center, Houston, Texas; and Breast Imaging Lead in Prevention, Breast Committee, DI Committee of the Alliance
| | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; Governor, ABR; and Board Member, SBI
| | | | - John R Scheel
- Fellowship Director, University of Washington, Seattle, Washington
| | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Katherine Yao
- NorthShore University HealthSystem, Evanston, Illinois; Vice Chair, National Accreditation Program for Breast Centers; and American College of Surgeons
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York; Chair, ACR NMD Registry; Senior Deputy Editor, Radiology; and Advisory Board, iCAD and Lunit
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Åhsberg K, Gardfjell A, Nimeus E, Ryden L, Zackrisson S. The PROCEM study protocol: Added value of preoperative contrast-enhanced mammography in staging of malignant breast lesions - a prospective randomized multicenter study. BMC Cancer 2021; 21:1115. [PMID: 34663236 PMCID: PMC8521511 DOI: 10.1186/s12885-021-08832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Correct preoperative estimation of the malignant extent is crucial for optimal planning of breast cancer surgery. The sensitivity of mammography is lower in dense breasts, and additional imaging techniques are sometimes warranted. Contrast-enhanced mammography (CEM) has shown similar sensitivity and in some cases better specificity, than magnetic resonance imaging (MRI) in small, observational studies. CEM may be more cost-effective than MRI, and may provide better identification of the tumor extent, however, no randomized trials have been performed to date to investigate the added value of CEM. In a feasibility study, we found that the treatment was changed in 10/47 (21%) cases after additional CEM. The purpose of the present study is to evaluate the added value of CEM in preoperative staging of breast cancer in a randomized study. METHOD This prospective randomized study will include 440 patients with strongly suspected or established diagnosis of breast malignancy, based on assessment with mammography, ultrasound and core biopsy/cytology, and for whom primary surgery is planned. Patients will be randomized 1:1 using a web-based randomization tool to additional investigation with CEM or no further imaging. The CEM findings will be taken into consideration, which may lead to changes in primary treatment, which is the primary endpoint of this study. Secondary endpoints include rate of reoperation and number of avoidable mastectomies, as well as a cost-benefit analysis of additional CEM. Patient-reported health-related quality of life will be investigated at 1 year with the validated Breast-Q™ questionnaire. The rate of local recurrence or new cancer ipsi- or contralaterally within 5 years will be assessed from medical records and pathology reports. DISCUSSION The aim of this trial is to explore the added value of CEM in preoperative staging of breast cancer. The results obtained from this study will contribute to our knowledge on CEM as an additional imaging method to standard investigation with digital mammography and ultrasound. The findings may also provide additional information on which patient groups would benefit from CEM, and on the economic aspects of CEM in standard preoperative practice. TRIAL REGISTRATION This trial is registered at clinicaltrials.gov , registration no: NCT04437602 , date of registration: June 18, 2020.
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Affiliation(s)
- Kristina Åhsberg
- Department of Surgery, Halland Hospital, 301 85, Halmstad, Sweden.
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.
| | - Anna Gardfjell
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden
| | - Emma Nimeus
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Oncology, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Lisa Ryden
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Oncology, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Sophia Zackrisson
- Department of Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden
- Diagnostic Radiology, Department of Translational Medicine, Lund University, Lund, Sweden
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17
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Gilbert FJ, Hickman SE, Baxter GC, Allajbeu I, James J, Caraco C, Vinnicombe S. Opportunities in cancer imaging: risk-adapted breast imaging in screening. Clin Radiol 2021; 76:763-773. [PMID: 33820637 DOI: 10.1016/j.crad.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/19/2021] [Indexed: 12/17/2022]
Abstract
In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible.
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Affiliation(s)
- F J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S E Hickman
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - G C Baxter
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - I Allajbeu
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J James
- Nottingham Breast Institute, City Hospital, Nottingham, UK
| | - C Caraco
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - S Vinnicombe
- Thirlestaine Breast Centre, Cheltenham, UK; Ninewells Hospital and Medical School, University of Dundee, UK
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18
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Radiomics and Artificial Intelligence Analysis with Textural Metrics Extracted by Contrast-Enhanced Mammography in the Breast Lesions Classification. Diagnostics (Basel) 2021; 11:diagnostics11050815. [PMID: 33946333 PMCID: PMC8146084 DOI: 10.3390/diagnostics11050815] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/29/2022] Open
Abstract
The aim of the study was to estimate the diagnostic accuracy of textural features extracted by dual-energy contrast-enhanced mammography (CEM) images, by carrying out univariate and multivariate statistical analyses including artificial intelligence approaches. In total, 80 patients with known breast lesion were enrolled in this prospective study according to regulations issued by the local Institutional Review Board. All patients underwent dual-energy CEM examination in both craniocaudally (CC) and double acquisition of mediolateral oblique (MLO) projections (early and late). The reference standard was pathology from a surgical specimen for malignant lesions and pathology from a surgical specimen or fine needle aspiration cytology, core or Tru-Cut needle biopsy, and vacuum assisted breast biopsy for benign lesions. In total, 104 samples of 80 patients were analyzed. Furthermore, 48 textural parameters were extracted by manually segmenting regions of interest. Univariate and multivariate approaches were performed: non-parametric Wilcoxon–Mann–Whitney test; receiver operating characteristic (ROC), linear classifier (LDA), decision tree (DT), k-nearest neighbors (KNN), artificial neural network (NNET), and support vector machine (SVM) were utilized. A balancing approach and feature selection methods were used. The univariate analysis showed low accuracy and area under the curve (AUC) for all considered features. Instead, in the multivariate textural analysis, the best performance considering the CC view (accuracy (ACC) = 0.75; AUC = 0.82) was reached with a DT trained with leave-one-out cross-variation (LOOCV) and balanced data (with adaptive synthetic (ADASYN) function) and a subset of three robust textural features (MAD, VARIANCE, and LRLGE). The best performance (ACC = 0.77; AUC = 0.83) considering the early-MLO view was reached with a NNET trained with LOOCV and balanced data (with ADASYN function) and a subset of ten robust features (MEAN, MAD, RANGE, IQR, VARIANCE, CORRELATION, RLV, COARSNESS, BUSYNESS, and STRENGTH). The best performance (ACC = 0.73; AUC = 0.82) considering the late-MLO view was reached with a NNET trained with LOOCV and balanced data (with ADASYN function) and a subset of eleven robust features (MODE, MEDIAN, RANGE, RLN, LRLGE, RLV, LZLGE, GLV_GLSZM, ZSV, COARSNESS, and BUSYNESS). Multivariate analyses using pattern recognition approaches, considering 144 textural features extracted from all three mammographic projections (CC, early MLO, and late MLO), optimized by adaptive synthetic sampling and feature selection operations obtained the best results (ACC = 0.87; AUC = 0.90) and showed the best performance in the discrimination of benign and malignant lesions.
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19
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Jochelson MS, Lobbes MBI. Contrast-enhanced Mammography: State of the Art. Radiology 2021; 299:36-48. [PMID: 33650905 PMCID: PMC7997616 DOI: 10.1148/radiol.2021201948] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
Contrast-enhanced mammography (CEM) has emerged as a viable alternative to contrast-enhanced breast MRI, and it may increase access to vascular imaging while reducing examination cost. Intravenous iodinated contrast materials are used in CEM to enhance the visualization of tumor neovascularity. After injection, imaging is performed with dual-energy digital mammography, which helps provide a low-energy image and a recombined or iodine image that depict enhancing lesions in the breast. CEM has been demonstrated to help improve accuracy compared with digital mammography and US in women with abnormal screening mammographic findings or symptoms of breast cancer. It has also been demonstrated to approach the accuracy of breast MRI in preoperative staging of patients with breast cancer and in monitoring response after neoadjuvant chemotherapy. There are early encouraging results from trials evaluating CEM in the screening of women who are at an increased risk of breast cancer. Although CEM is a promising tool, it slightly increases radiation dose and carries a small risk of adverse reactions to contrast materials. This review details the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics.
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Affiliation(s)
- Maxine S. Jochelson
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (M.S.J.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands (M.B.I.L.)
| | - Marc B. I. Lobbes
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (M.S.J.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands (M.B.I.L.)
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Abstract
Early detection is of great importance for the successful treatment of breast cancer and for a good prognosis. Contrast-enhanced mammography and especially contrast-enhanced spectral mammography (CESM) show promising initial results and are a valuable addition to currently available methods. The advantage of these methods is that imaging of both breasts can be performed in a single examination with a single contrast agent application. The accuracy of CESM is similar to that of magnetic resonance imaging (MRI), easily available at low costs, which is why this procedure is increasingly used in the diagnostic work up of breast cancer. CESM is also a good alternative to MRI if this cannot be performed due to contraindications.
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Affiliation(s)
- Eva M Fallenberg
- Bereichsleitung: Diagnostische und interventionelle Senologie LMU, Klinik und Poliklinik für Radiologie, Campus Innenstadt/Großhadern, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
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21
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Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clin Imaging 2021; 69:269-279. [PMID: 33032103 PMCID: PMC8494428 DOI: 10.1016/j.clinimag.2020.09.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced mammography (CEM) combines conventional mammography with iodinated contrast material to improve cancer detection. CEM has comparable performance to breast MRI without the added cost or time of conventional MRI protocols. Thus, this technique may be useful for indications previously reserved for MRI, such as problem-solving, determining disease extent in patients with newly diagnosed cancer, monitoring response to neoadjuvant therapy, evaluating the posttreatment breast for residual or recurrent disease, and potentially screening in women at intermediate- or high-risk for breast cancer. This article will provide a comprehensive overview on the past, present, and future of CEM, including its evolving role in the diagnostic and screening settings.
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Affiliation(s)
- Julie Sogani
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Victoria L Mango
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
| | - Delia Keating
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Janice S Sung
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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Gluskin J, Rossi Saccarelli C, Avendano D, Marino MA, Bitencourt AGV, Pilewskie M, Sevilimedu V, Sung JS, Pinker K, Jochelson MS. Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery. Cancers (Basel) 2020; 12:cancers12123495. [PMID: 33255412 PMCID: PMC7760311 DOI: 10.3390/cancers12123495] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer survivors are at risk for recurrence, and the early detection of recurrence improves survival. Therefore, imaging surveillance is performed for women who have breast-conserving surgery. The aim of our retrospective study was to compare routine mammography with contrast-enhanced mammography in the screening (asymptomatic) post-treatment setting. We confirmed that when screening women with breast conservation surgery, contrast-enhanced mammography had a higher cancer detection rate (15.4/1000) and positive predictive value of biopsies (42.9%) than full-field digital mammography (6.2/1000 and 37.5%, respectively). Abstract To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.
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Affiliation(s)
- Jill Gluskin
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP 01308-050, Brazil
| | - Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, 64718 Nuevo Leon, Mexico
| | - Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, 64718 Messina, Italy
| | - Almir G. V. Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP 01509-010, Brazil
| | - Melissa Pilewskie
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Janice S. Sung
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Maxine S. Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Correspondence: ; Tel.: +1-646-888-4507
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Contrast-Enhanced Digital Mammography: Technique, Clinical Applications, and Pitfalls. AJR Am J Roentgenol 2020; 215:1267-1278. [PMID: 32877247 DOI: 10.2214/ajr.19.22412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE. Contrast-enhanced digital mammography (CEDM) combines the high spatial resolution of mammography with the improved enhancement provided by contrast medium. In this article, CEDM technique-the current and potential clinical applications and current challenges-will be reviewed. CONCLUSION. CEDM is a promising technique in the supplemental evaluation of patients with mammographically inconclusive findings and potentially in the screening of women with mammographically dense breasts. CEDM is emerging as a cost-effective alternative to dynamic contrast-enhanced MRI to stage newly diagnosed breast cancer and evaluate response to neoadjuvant chemotherapy.
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Covington MF. Contrast-Enhanced Mammography Implementation, Performance, and Use for Supplemental Breast Cancer Screening. Radiol Clin North Am 2020; 59:113-128. [PMID: 33222993 DOI: 10.1016/j.rcl.2020.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology that provides recombined contrast-enhanced images of the breast in addition to low-energy images analogous to a 2-dimensional full-field digital mammogram. Because most breast imaging centers do not use CEM at this time, a detailed overview of CEM implementation and performance is presented. Thereafter, the potential use of CEM for supplemental screening is discussed in detail, given the importance of this topic for the future of the CEM community. Diagnostic performance, safety, and cost considerations of CEM for dense breast tissue supplemental screening are discussed.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
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González-Huebra I, Malmierca P, Elizalde A, Etxano J, Vejborg I, Uhlenbrock D, Pina L. The accuracy of titanium contrast-enhanced mammography: a retrospective multicentric study. Acta Radiol 2020; 61:1335-1342. [PMID: 31979977 DOI: 10.1177/0284185119900440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recently, a new mammography system to perform contrast-enhanced mammography has become available in the market. For the high-energy acquisition, it uses a titanium filter instead of a copper one, reducing the tube load while maintaining image quality. PURPOSE To retrospectively evaluate the accuracy of contrast-enhanced mammography with a titanium filter (TiCEM) in three readers with different grades of experience. MATERIAL AND METHODS IRB-approved retrospective multicentric lesion by lesion study with 200 lesions, all of them initially classified as BI-RADS categories 0/3/4/5 on mammography and/or ultrasound and with pathological confirmation, in 135 patients. Three readers with different levels of experience (expert, resident, intermediate) blinded to the final diagnosis, retrospectively evaluated the low-energy (LE) images and the combination of LE and recombined (subtracted) images and classified the lesions according to the BI-RADS categories. Reader 1 also categorized the breast density. ROC curves were performed for each reader. RESULTS Out of the 200 lesions, 82 were benign and 118 malignant (20 DCIS, 10 ILC, 88 IDC). The AUCs of LE versus TiCEM for were: Reader 1: 0.7 vs. 0.88, P < 0.001; Reader 2: 0.63 vs. 0.83, P < 0.001; and Reader 3: 0.63 vs. 0.84, P < 0.001. For the three readers, the AUCs of LE versus TiCEM were significantly superior in both dense and non-dense breasts (P < 0.001). Comparing the AUC of LE for Reader 1 (expert) versus the AUC of TiCEM for Reader 2 (resident) there were significant differences (0.7 vs. 0.83, P < 0.001). CONCLUSION The accuracy of TiCEM was significantly better for all the readers, in both dense and non-dense breasts. The accuracy of a resident reading a TiCEM study was better than the accuracy of an expert radiologist reading LE images.
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Affiliation(s)
| | - Patricia Malmierca
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Arlette Elizalde
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jon Etxano
- Department of Radiology, Osatek SA, Vitoria, País Vasco, Spain
| | - Ilse Vejborg
- Breast Imaging Section, Righospitalet, Copenhagen, Denmark
| | | | - Luis Pina
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Lu Z, Hao C, Pan Y, Mao N, Wang X, Yin X. Contrast-Enhanced Spectral Mammography Versus Ultrasonography: Diagnostic Performance in Symptomatic Patients with Dense Breasts. Korean J Radiol 2020; 21:442-449. [PMID: 32193892 PMCID: PMC7082654 DOI: 10.3348/kjr.2019.0393] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 11/17/2019] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) versus ultrasonography (US) in symptomatic patients with dense breasts, while using histology as the gold standard. Materials and Methods After obtaining approval from the local ethics board, this prospective study collected data from patients with symptomatic breasts who underwent CESM and US examinations from May 1, 2017 to September 30, 2017. We then selected those with dense breasts and pathological results as our sample population. Both CESM and US results were classified by a radiologist through the Breast Imaging Reporting and Data System, and the results were compared with their corresponding histological results. The chi-square test was conducted to compare the diagnostic performance of CESM and US, and the receiver operating characteristic curves for the two imaging modalities were obtained. Results A total of 131 lesions from 115 patients with dense breasts were included in this study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 93.8%, 88.1%, 88.2%, 93.7%, and 90.8% for CESM, and 90.6%, 82.1%, 82.9%, 90.2%, and 86.3% for US, respectively. The p values for sensitivity, specificity, PPV, NPV, and accuracy were 0.687, 0.388, 0.370, 0.702, and 0.238, respectively. The area under the curve of CESM (0.917) was comparable with that of US (0.884); however, the differences between CESM and US were not statistically significant (p = 0.225). Eight false-positive cases and 4 false-negative cases for breast cancer were found in CESM, while 12 false-positive cases and 6 false-negative cases were found in US. Conclusion The diagnostic performances of CESM and US are comparable in symptomatic women with dense breasts; however, the routine use of additional US imaging is questionable for lesions that can be detected by CESM.
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Affiliation(s)
- Zhongfei Lu
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Cuijuan Hao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yan Pan
- Department of Ultrasound, Yantai Yuhuangding Hospital, Yantai, China.
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xin Wang
- Department of Ultrasound, Yantai Yuhuangding Hospital, Yantai, China
| | - Xundi Yin
- Department of Ultrasound, Yantai Yuhuangding Hospital, Yantai, China
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La Forgia D, Fanizzi A, Campobasso F, Bellotti R, Didonna V, Lorusso V, Moschetta M, Massafra R, Tamborra P, Tangaro S, Telegrafo M, Pastena MI, Zito A. Radiomic Analysis in Contrast-Enhanced Spectral Mammography for Predicting Breast Cancer Histological Outcome. Diagnostics (Basel) 2020; 10:E708. [PMID: 32957690 PMCID: PMC7555402 DOI: 10.3390/diagnostics10090708] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Contrast-Enhanced Spectral Mammography (CESM) is a recently introduced mammographic method with characteristics particularly suitable for breast cancer radiomic analysis. This work aims to evaluate radiomic features for predicting histological outcome and two cancer molecular subtypes, namely Human Epidermal growth factor Receptor 2 (HER2)-positive and triple-negative. From 52 patients, 68 lesions were identified and confirmed on histological examination. Radiomic analysis was performed on regions of interest (ROIs) selected from both low-energy (LE) and ReCombined (RC) CESM images. Fourteen statistical features were extracted from each ROI. Expression of estrogen receptor (ER) was significantly correlated with variation coefficient and variation range calculated on both LE and RC images; progesterone receptor (PR) with skewness index calculated on LE images; and Ki67 with variation coefficient, variation range, entropy and relative smoothness indices calculated on RC images. HER2 was significantly associated with relative smoothness calculated on LE images, and grading tumor with variation coefficient, entropy and relative smoothness calculated on RC images. Encouraging results for differentiation between ER+/ER-, PR+/PR-, HER2+/HER2-, Ki67+/Ki67-, High-Grade/Low-Grade and TN/NTN were obtained. Specifically, the highest performances were obtained for discriminating HER2+/HER2- (90.87%), ER+/ER- (83.79%) and Ki67+/Ki67- (84.80%). Our results suggest an interesting role for radiomics in CESM to predict histological outcomes and particular tumors' molecular subtype.
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Affiliation(s)
- Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Francesco Campobasso
- Dipartimento di Economia e Finanza, Università degli Studi di Bari “Aldo Moro”, Largo Abbazia S. Scolastica, 70124 Bari, Italy;
| | - Roberto Bellotti
- Dipartimento Interateneo di Fisica, Università degli Studi di Bari “Aldo Moro”, Via Giovanni Amendola, 165/a, 70126 Bari, Italy;
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Via Giovanni Amendola, 165/a, 70126 Bari, Italy;
| | - Vittorio Didonna
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Vito Lorusso
- Unità Operativa Complessa di Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Marco Moschetta
- Unità Operativa Semplice Dipartimentale Radiodiagnostica ad Indirizzo Senologico, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (M.T.)
| | - Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Pasquale Tamborra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Sabina Tangaro
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Via Giovanni Amendola, 165/a, 70126 Bari, Italy;
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari Aldo Moro, 70121 Bari, Italy
| | - Michele Telegrafo
- Unità Operativa Semplice Dipartimentale Radiodiagnostica ad Indirizzo Senologico, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (M.T.)
| | - Maria Irene Pastena
- Unità Operativa Complessa di Anatomia Patologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (M.I.P.); (A.Z.)
| | - Alfredo Zito
- Unità Operativa Complessa di Anatomia Patologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (M.I.P.); (A.Z.)
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Chi X, Zhang L, Xing D, Gong P, Chen Q, Lv Y. Diagnostic value of the enhancement intensity and enhancement pattern of CESM to benign and malignant breast lesions. Medicine (Baltimore) 2020; 99:e22097. [PMID: 32925753 PMCID: PMC7489654 DOI: 10.1097/md.0000000000022097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study aimed to improve the diagnostic accuracy of breast diseases by combining breast imaging-reporting and data system (BI-RADS) with the enhancement intensity and pattern of contrast-enhanced spectral mammography (CESM) (this combination of BI-RADS and CESM was designated as BaC).BI-RADS was used to evaluate low-energy CESM images. Spearman nonparametric correlation analysis was performed to analyze the correlation between the enhancement intensity of CESM subtraction images and the pathological results. Odds ratio (OR) values were calculated to determine whether the enhancement pattern of CESM subtraction images is a risk factor for benign and malignant lesions. The diagnostic efficacies of BI-RADS, CESM, and BaC scores for benign and malignant breast diseases were analyzed using the receiver operating characteristic (ROC) curve.Lesions with a high enhancement intensity were more likely to be malignant than those with low enhancement intensity. Lesions with heterogeneous enhancement tended to be malignant, whereas those with homogeneous enhancement tended to be benign. No significant correlation was observed between ring enhancement and the benignity or malignancy of lesions. The area under the ROC curve of BaC was higher than that of BI-RADS or CESM, and the difference was statistically significant.The diagnostic efficacy of BI-RADS combined with CESM enhancement was superior to that of either method alone.
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Affiliation(s)
- Xiaoxiao Chi
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University
| | - Lei Zhang
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong
| | - Dong Xing
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University
| | - Peiyou Gong
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University
| | - Qianqian Chen
- GE Healthcare, Institute of Precision Medicine, Shanghai, PR China
| | - Yongbin Lv
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University
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Abstract
Screening for breast cancer reduces breast cancer-related mortality and earlier detection facilitates less aggressive treatment. Unfortunately, current screening modalities are imperfect, suffering from limited sensitivity and high false-positive rates. Novel techniques in the field of breast imaging may soon play a role in breast cancer screening: digital breast tomosynthesis, contrast material-enhanced spectral mammography, US (automated three-dimensional breast US, transmission tomography, elastography, optoacoustic imaging), MRI (abbreviated and ultrafast, diffusion-weighted imaging), and molecular breast imaging. Artificial intelligence and radiomics have the potential to further improve screening strategies. Furthermore, nonimaging-based screening tests such as liquid biopsy and breathing tests may transform the screening landscape. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Ritse M Mann
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Regina Hooley
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Richard G Barr
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
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Bozzini A, Nicosia L, Pruneri G, Maisonneuve P, Meneghetti L, Renne G, Vingiani A, Cassano E, Mastropasqua MG. Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study. Breast Cancer Res Treat 2020; 184:723-731. [PMID: 32860166 PMCID: PMC7655556 DOI: 10.1007/s10549-020-05881-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the efficacy of contrast-enhanced spectral mammography, with ultrasound, full field digital mammography and magnetic resonance imaging in detection and size estimation of histologically proven breast tumors. METHODS This open-label, single center, prospective study, included 160 dense breast women with at least one suspicious mammary lesion evaluated by ultrasound, full field digital mammography and magnetic resonance imaging in whom a mammary tumor was histologically proven after surgery performed at the European Institute of Oncology between January 2013 and December 2015. Following the complete diagnostic procedure, the patients were further investigated by contrast-enhanced spectral mammography prior to surgery. RESULTS Overall, the detection rate of malignant breast lesions (in situ and invasive) was 93.8% (165/176) for contrast-enhanced spectral mammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field digital mammography and 97.7% (173/177) for magnetic resonance imaging. Radiological measurements were concordant with the post-surgical pathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% for contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% for full field digital mammography (p < 0.0001) and 69.9% for magnetic resonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced spectral mammography, 19.6% for ultrasound, 24.2% for full field digital mammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = 0.0005); and overestimated in: 16.2% for contrast-enhanced spectral mammography, 16.6% for ultrasound, 16.6% for full field digital mammography and 22.7% for magnetic resonance imaging (p = 0.02). CONCLUSIONS Our data suggest that contrast-enhanced spectral mammography improves on full field digital mammography and is comparable to ultrasound and magnetic resonance imaging in terms of detection sensitivity and size estimation of malignant lesions in dense breasts.
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Affiliation(s)
- Anna Bozzini
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Luca Nicosia
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Giancarlo Pruneri
- School of Medicine, University of Milan, Milan, Italy
- Department of Pathology, Fondazione IRCCS Istituto Nazionali Tumori Milano, Via G. Venezian, 1, 20133 Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Giuseppe Renne
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141 Milan, Italy
| | - Andrea Vingiani
- School of Medicine, University of Milan, Milan, Italy
- Department of Pathology, Fondazione IRCCS Istituto Nazionali Tumori Milano, Via G. Venezian, 1, 20133 Milan, Italy
| | - Enrico Cassano
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Mauro Giuseppe Mastropasqua
- School of Medicine, University of Bari, Bari, Italy
- Department of Emergency and Organ Transplantations, Section of Anatomic Pathology, Piazza G. Cesare 11, 70124 Bari, Italy
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Tang S, Xiang C, Yang Q. The diagnostic performance of CESM and CE-MRI in evaluating the pathological response to neoadjuvant therapy in breast cancer: a systematic review and meta-analysis. Br J Radiol 2020; 93:20200301. [PMID: 32574075 PMCID: PMC7446000 DOI: 10.1259/bjr.20200301] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Neoadjuvant chemotherapy (NAC) is an important method for breast cancer treatment. By monitoring its pathological response, the selection of clinical treatment strategies can be guided. In this study, the meta-analysis was used to compare the accuracy of contrast-enhanced MRI (CE-MRI) and contrast-enhanced spectral mammography (CESM) in detecting the pathological response of NAC. METHODS Literatures associated to CE-MRI and CESM in the evaluation of pathological response of NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the quality of studies. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to evaluate the diagnostic accuracy of CE-MRI and CESM in monitoring the pathological response of NAC. RESULTS There were 24 studies involved, 18 of which only underwent CE-MRI examination, three of which only underwent CESM examination, and three of which underwent both CE-MRI and CESM examination. The pooled sensitivity and specificity of CE-MRI were 0.77 (95%CI, 0.67-0.84) and 0.82 (95%CI, 0.73-0.89), respectively. The pooled sensitivity and specificity of CESM were 0.83 (95%CI, 0.66-0.93) and 0.82 (95%CI, 0.68-0.91), respectively. The AUCs of SROC curve for CE-MRI and CESM were 0.86 and 0.89, respectively. CONCLUSIONS Compared to CE-MRI, CESM has equal specificity, greater sensitivity and excellent performance, which may have a brighter prospect in evaluating the pathological response of breast cancer to NAC. ADVANCES IN KNOWLEDGE CESM showed equal specificity, greater sensitivity, and excellent performance than CE-MRI.
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Affiliation(s)
- Sudan Tang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
| | - Chunhong Xiang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
| | - Quan Yang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
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Suter MB, Pesapane F, Agazzi GM, Gagliardi T, Nigro O, Bozzini A, Priolo F, Penco S, Cassano E, Chini C, Squizzato A. Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. Breast 2020; 53:8-17. [PMID: 32540554 PMCID: PMC7375655 DOI: 10.1016/j.breast.2020.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%-91%], with a sensitivity of 85% [95% CI 73%-93%], and a specificity of 77% [95% CI 60%-88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.
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Affiliation(s)
| | - Filippo Pesapane
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Giorgio Maria Agazzi
- University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Tania Gagliardi
- Department of Radiology, Royal Marsden Hospital, London, UK.
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
| | - Anna Bozzini
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Francesca Priolo
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Silvia Penco
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Enrico Cassano
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Claudio Chini
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
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Åhsberg K, Gardfjell A, Nimeus E, Rasmussen R, Behmer C, Zackrisson S, Ryden L. Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions-a feasibility study. World J Surg Oncol 2020; 18:100. [PMID: 32438917 PMCID: PMC7243325 DOI: 10.1186/s12957-020-01865-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of this feasibility study was to evaluate the added value of contrast-enhanced mammography (CEM) in preoperative staging of malignant breast lesions, beyond standard assessment with digital mammography and ultrasound, as a base for a future prospective randomized trial. MATERIALS AND METHODS Forty-seven patients, with confirmed or strongly suspected malignant breast lesions after standard assessment (digital mammography (DM) and ultrasound (US)), scheduled for primary surgery, were invited to undergo CEM as an additional preoperative procedure. The primary endpoint was change in treatment due to CEM findings, defined as mastectomy instead of partial mastectomy or contrariwise, bilateral surgery instead of unilateral or neoadjuvant treatment instead of primary surgery. Accuracy in tumour extent estimation compared to histopathology was evaluated by Bland-Altman statistics. Number of extra biopsies and adverse events were recorded. RESULTS In 10/47 patients (21%), findings from CEM affected the primary treatment. Agreement with histopathology regarding extent estimation was better for CEM (mean difference - 1.36, SD ± 18.45) in comparison with DM (- 4.18, SD ± 26.20) and US (- 8.36, SD ± 24.30). Additional biopsies were taken from 19 lesions in 13 patients. Nine biopsies showed malignant outcome. No major adverse events occurred. CONCLUSION The feasibility of preoperative additional CEM was found to be satisfactory without any serious negative effects. Results imply an added value of CEM in preoperative staging of breast cancer. Further evaluation in larger prospective randomized trials is needed. TRIAL REGISTRATION ClinicalTrials.gov, NCT03402529. Registered 18 January 2018-retrospectively registered.
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Affiliation(s)
- Kristina Åhsberg
- Department of Surgery, Halland Hospital, 301 85, Halmstad, Sweden. .,Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.
| | - Anna Gardfjell
- Department of Surgery, Blekinge Hospital, Karlskrona, Sweden
| | - Emma Nimeus
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden.,Institution of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden
| | - Rogvi Rasmussen
- Unilabs Breast Centre, Skåne University Hospital, Lund, Sweden
| | - Catharina Behmer
- Unilabs Breast Centre, Helsingborg Hospital, Helsingborg, Sweden
| | - Sophia Zackrisson
- Department of Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden.,Diagnostic Radiology, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Lisa Ryden
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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Miller MM, Repich K, Patrie JT, Anderson RT, Harvey JA. Preferences and Attitudes Regarding Adjunct Breast Cancer Screening Among Patients with Dense Breasts. JOURNAL OF BREAST IMAGING 2020; 2:119-124. [PMID: 38424895 DOI: 10.1093/jbi/wbz093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE New breast screening modalities are being investigated to address the need for more sensitive breast cancer screening in women with dense breasts. We investigated the preferences and attitudes of these patients regarding adjunct screening modalities to help evaluate the acceptability of these exams. METHODS In this institutional review board-approved prospective study, patients with dense breasts on their prior mammogram were invited to complete a survey. Patients were asked to estimate their personal breast cancer risk compared with peers, indicate their level of concern related to screening callbacks, radiation exposure, and intravenous (IV) contrast allergies, and identify which factors might deter them from getting adjunct screening exams. RESULTS Five hundred eight patients with dense breasts presenting for screening mammography completed surveys. While most patients (304/508, 59.9%) felt it was likely or very likely that cancer could be missed on their mammogram, only 8.9% (45/508) had undergone adjunct screening exams in the past 3 years. The most commonly cited deterrents to adjunct screening were cost (340/508, 66.9%), pain (173/508, 34.1%), and concern that adjunct screening could lead to additional procedures (158/508, 31.1%). When asked to select among three hypothetical breast cancer screening modalities, patients strongly preferred the more sensitive examination, even if this involved greater cost (162/508, 31.9%) or IV-contrast administration (315/508, 62.0%). CONCLUSION Our data suggest that patients with dense breasts prefer adjunct screening exams that are both sensitive and inexpensive, although an increase in sensitivity could outweigh additional cost or even IV-line placement.
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Affiliation(s)
- Matthew M Miller
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA
| | - Kathy Repich
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA
| | - James T Patrie
- University of Virginia School of Medicine, Department of Public Health Sciences, Charlottesville, VA
| | - Roger T Anderson
- University of Virginia School of Medicine, Department of Public Health Sciences, Charlottesville, VA
| | - Jennifer A Harvey
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA
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Outcomes of screening mammography in women less than 40 prior to fertility treatment: a retrospective pilot study. Clin Imaging 2019; 59:109-113. [PMID: 31812882 DOI: 10.1016/j.clinimag.2019.11.003] [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: 07/17/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE There are currently no evidence-based guidelines regarding breast cancer screening in women under 40 prior to initiating assisted reproductive technology (ART). The prevalence of abnormal findings on screening mammography in this population is unknown. The purpose of this study was to describe screening mammography outcomes in women less than 40 years old, referred for the indication of pre-ART. MATERIALS, METHODS, PROCEDURES This is a retrospective review of women less than 40 years old presenting for screening mammography prior to ART between January 2010 and March 2017. Clinical history, breast cancer risk factors, imaging and pathology results were gathered from the electronic medical record. RESULTS The study included 80 women. Mean patient age was 37 years (range 34-39 years). Sixty-seven (84%) had negative or benign screening (BI-RADS 1 or 2) and 13 (16%) were recalled for diagnostic imaging (BI-RADS 0). Four of 13 (31%) recalled women were given BI-RADS 1 or 2 at diagnostic work-up, 4 (31%) were given a BI-RADS 3, and 5 (38%) were recommended for biopsy (BI-RADS 4). At patient request, 2 of 4 (50%) BI-RADS 3 cases underwent biopsy, for 7 total biopsies. Six (86%) biopsies yielded benign results and 1 (14%) yielded DCIS. Overall cancer yield was 1.3%. CONCLUSION In women under 40 who plan to undergo ART, screening mammography may identify breast malignancies. This may be of particular importance given many breast cancers are hormone sensitive, and thus fertility treatments may affect tumor growth. Future, larger studies are needed.
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Radiomics Analysis on Contrast-Enhanced Spectral Mammography Images for Breast Cancer Diagnosis: A Pilot Study. ENTROPY 2019. [PMCID: PMC7514454 DOI: 10.3390/e21111110] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Contrast-enhanced spectral mammography is one of the latest diagnostic tool for breast care; therefore, the literature is poor in radiomics image analysis useful to drive the development of automatic diagnostic support systems. In this work, we propose a preliminary exploratory analysis to evaluate the impact of different sets of textural features in the discrimination of benign and malignant breast lesions. The analysis is performed on 55 ROIs extracted from 51 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) from the breast cancer screening phase between March 2017 and June 2018. We extracted feature sets by calculating statistical measures on original ROIs, gradiented images, Haar decompositions of the same original ROIs, and on gray-level co-occurrence matrices of the each sub-ROI obtained by Haar transform. First, we evaluated the overall impact of each feature set on the diagnosis through a principal component analysis by training a support vector machine classifier. Then, in order to identify a sub-set for each set of features with higher diagnostic power, we developed a feature importance analysis by means of wrapper and embedded methods. Finally, we trained an SVM classifier on each sub-set of previously selected features to compare their classification performances with respect to those of the overall set. We found a sub-set of significant features extracted from the original ROIs with a diagnostic accuracy greater than 80 % . The features extracted from each sub-ROI decomposed by two levels of Haar transform were predictive only when they were all used without any selection, reaching the best mean accuracy of about 80 % . Moreover, most of the significant features calculated by HAAR decompositions and their GLCMs were extracted from recombined CESM images. Our pilot study suggested that textural features could provide complementary information about the characterization of breast lesions. In particular, we found a sub-set of significant features extracted from the original ROIs, gradiented ROI images, and GLCMs calculated from each sub-ROI previously decomposed by the Haar transform.
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Sung JS, Lebron L, Keating D, D'Alessio D, Comstock CE, Lee CH, Pike MC, Ayhan M, Moskowitz CS, Morris EA, Jochelson MS. Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer. Radiology 2019; 293:81-88. [PMID: 31453765 DOI: 10.1148/radiol.2019182660] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BackgroundContrast agent-enhanced digital mammography (CEDM) has been shown to be more sensitive and specific than two-dimensional full-field digital mammography in the diagnostic setting. Few studies have reported on its performance in the screening setting.PurposeTo evaluate the performance of CEDM for breast cancer screening.Materials and MethodsThis retrospective study included women who underwent dual-energy CEDM for breast cancer screening from December 2012 through April 2016. Medical records were reviewed for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected. Sensitivity, specificity, positive predictive value of abnormal findings at screening (PPV1), positive predictive value of biopsy performed (PPV3), and negative predictive value were determined.ResultsIn the study period 904 baseline CEDMs were performed. Mean age was 51.8 years ± 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV3 was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; P = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%).ConclusionContrast-enhanced digital mammography is a promising technique for screening women with higher-than-average risk for breast cancer.© RSNA, 2019.
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Affiliation(s)
- Janice S Sung
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Lizza Lebron
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Delia Keating
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Donna D'Alessio
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Christopher E Comstock
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Carol H Lee
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Malcolm C Pike
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Miranda Ayhan
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Chaya S Moskowitz
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Elizabeth A Morris
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Maxine S Jochelson
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
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Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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Alexander S, Dulku G, Hashoul S, Taylor DB. Practical uses of contrast-enhanced spectral mammography in daily work: A pictorial review. J Med Imaging Radiat Oncol 2019; 63:473-478. [PMID: 31332941 DOI: 10.1111/1754-9485.12927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
Contrast-enhanced spectral mammography (CESM) has a number of uses including the work-up of inconclusive findings on mammography, assessment of breast symptoms, cancer staging, evaluation of response to neoadjuvant chemotherapy and recently as an alternative to magnetic resonance imaging (MRI) in high-risk screening. CESM can be swiftly incorporated into the workflow of busy breast clinics. We share our experiences with CESM at a large breast assessment centre in Western Australia.
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Affiliation(s)
- Sweeka Alexander
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Gurjeet Dulku
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sharbell Hashoul
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Fanizzi A, Losurdo L, Basile TMA, Bellotti R, Bottigli U, Delogu P, Diacono D, Didonna V, Fausto A, Lombardi A, Lorusso V, Massafra R, Tangaro S, La Forgia D. Fully Automated Support System for Diagnosis of Breast Cancer in Contrast-Enhanced Spectral Mammography Images. J Clin Med 2019; 8:jcm8060891. [PMID: 31234363 PMCID: PMC6616937 DOI: 10.3390/jcm8060891] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 12/24/2022] Open
Abstract
Contrast-Enhanced Spectral Mammography (CESM) is a novelty instrumentation for diagnosing of breast cancer, but it can still be considered operator dependent. In this paper, we proposed a fully automatic system as a diagnostic support tool for the clinicians. For each Region Of Interest (ROI), a features set was extracted from low-energy and recombined images by using different techniques. A Random Forest classifier was trained on a selected subset of significant features by a sequential feature selection algorithm. The proposed Computer-Automated Diagnosis system is tested on 48 ROIs extracted from 53 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) from the breast cancer screening phase between March 2017 and June 2018. The present method resulted highly performing in the prediction of benign/malignant ROIs with median values of sensitivity and specificity of 87.5% and 91.7%, respectively. The performance was high compared to the state-of-the-art, even with a moderate/marked level of parenchymal background. Our classification model outperformed the human reader, by increasing the specificity over 8%. Therefore, our system could represent a valid support tool for radiologists for interpreting CESM images, both reducing the false positive rate and limiting biopsies and surgeries.
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Affiliation(s)
- Annarita Fanizzi
- Dip. di Diagnosi e Terapia per Immagini, I.R.C.C.S. Istituto Tumori "Giovanni Paolo II" di Bari, 70124 Bari, Italy.
| | - Liliana Losurdo
- Dip. di Diagnosi e Terapia per Immagini, I.R.C.C.S. Istituto Tumori "Giovanni Paolo II" di Bari, 70124 Bari, Italy.
| | - Teresa Maria A Basile
- Dip. Interateneo di Fisica "M. Merlin", Università degli Studi di Bari "A. Moro", 70125 Bari, Italy.
| | - Roberto Bellotti
- Dip. Interateneo di Fisica "M. Merlin", Università degli Studi di Bari "A. Moro", 70125 Bari, Italy.
| | - Ubaldo Bottigli
- Dip. di Scienze Fisiche, della Terra e dell'Ambiente, Università degli Studi di Siena, 53100 Siena, Italy.
| | - Pasquale Delogu
- Dip. di Scienze Fisiche, della Terra e dell'Ambiente, Università degli Studi di Siena, 53100 Siena, Italy.
| | - Domenico Diacono
- INFN-Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70125 Bari, Italy.
| | - Vittorio Didonna
- Dip. di Diagnosi e Terapia per Immagini, I.R.C.C.S. Istituto Tumori "Giovanni Paolo II" di Bari, 70124 Bari, Italy.
| | - Alfonso Fausto
- Dip. di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.
| | - Angela Lombardi
- INFN-Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70125 Bari, Italy.
| | - Vito Lorusso
- Dip. Area Medica, I.R.C.C.S. Istituto Tumori "Giovanni Paolo II" di Bari, 70124 Bari, Italy.
| | - Raffaella Massafra
- Dip. di Diagnosi e Terapia per Immagini, I.R.C.C.S. Istituto Tumori "Giovanni Paolo II" di Bari, 70124 Bari, Italy.
| | - Sabina Tangaro
- INFN-Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70125 Bari, Italy.
| | - Daniele La Forgia
- Dip. di Diagnosi e Terapia per Immagini, I.R.C.C.S. Istituto Tumori "Giovanni Paolo II" di Bari, 70124 Bari, Italy.
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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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Dromain C, Vietti-Violi N, Meuwly JY. Angiomammography: A review of current evidences. Diagn Interv Imaging 2019; 100:593-605. [PMID: 30962168 DOI: 10.1016/j.diii.2019.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/26/2022]
Abstract
Although mammography is currently the imaging technique of choice for screening and diagnosis, it has some limitations, especially in patients with high-density breasts. The evolution from film screen to full-field digital mammography has recently led to the development of new imaging techniques, which are less expensive and widely available. Contrast-enhanced spectral mammography (CESM) is one of them, coupling X-ray breast imaging to the intravenous administration of an iodinated contrast material. CESM provides both morphological information, similar to mammography, and functional information of tumor perfusion. In this review, the imaging technique, the specificity of interpretation of CESM compared to MRI and the currently available data are presented. The clinical performances of CESM versus those of mammography and MRI and its additional value in preoperative local assessment and screening is discussed. The potential advantages and disadvantages are mentioned and we also discuss how CESM contributes to the detection of lesions and how it can be used in daily clinical workflow.
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Affiliation(s)
- C Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
| | - N Vietti-Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - J Y Meuwly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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Contrast-Enhanced Mammography: A Systematic Guide to Interpretation and Reporting. AJR Am J Roentgenol 2019; 212:222-231. [DOI: 10.2214/ajr.17.19265] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lancaster RB, Gulla S, De Los Santos J, Umphrey HR. Contrast-Enhanced Spectral Mammography in Breast Imaging. Semin Roentgenol 2018; 53:294-300. [PMID: 30449347 DOI: 10.1053/j.ro.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rachael B Lancaster
- Department of Surgery, University of Alabama at Birmingham Medical Center, Birmingham, AL 35233.
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Phillips J, Mihai G, Hassonjee SE, Raj SD, Palmer MR, Brook A, Zhang D. Comparative Dose of Contrast-Enhanced Spectral Mammography (CESM), Digital Mammography, and Digital Breast Tomosynthesis. AJR Am J Roentgenol 2018; 211:839-846. [DOI: 10.2214/ajr.17.19036] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jordana Phillips
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
| | - Georgeta Mihai
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
| | - Sarah Esaa Hassonjee
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
| | - Sean D. Raj
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
| | - Matthew R. Palmer
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
| | - Alexander Brook
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
| | - Da Zhang
- Department of Radiology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Ave, 4th Fl, Boston, MA 02215
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James J, Tennant S. Contrast-enhanced spectral mammography (CESM). Clin Radiol 2018; 73:715-723. [DOI: 10.1016/j.crad.2018.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022]
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Richter V, Hatterman V, Preibsch H, Bahrs SD, Hahn M, Nikolaou K, Wiesinger B. Contrast-enhanced spectral mammography in patients with MRI contraindications. Acta Radiol 2018; 59:798-805. [PMID: 29058963 DOI: 10.1177/0284185117735561] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method's technical limitations.
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Affiliation(s)
- Vivien Richter
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Valerie Hatterman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Sonja D Bahrs
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Markus Hahn
- Department of Obstetrics and Gynecology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Benjamin Wiesinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
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Zhu X, Huang JM, Zhang K, Xia LJ, Feng L, Yang P, Zhang MY, Xiao W, Lin HX, Yu YH. Diagnostic Value of Contrast-Enhanced Spectral Mammography for Screening Breast Cancer: Systematic Review and Meta-analysis. Clin Breast Cancer 2018; 18:e985-e995. [PMID: 29983379 DOI: 10.1016/j.clbc.2018.06.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/09/2018] [Accepted: 06/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contrast-enhanced spectral mammography (CESM) is a new image examination technology that has developed over the past few years. As CESM technology keeps improving, a current meta-analysis review is needed to systematically evaluate the potential diagnostic value of CESM. METHODS A total of 18 studies were included in the review. Sensitivity, specificity, and other important parameters of CESM accuracy for breast cancer diagnosis were pooled and analyzed using random-effects models. Summary receiver operating characteristic curves were calculated for overall accuracy estimation. RESULTS The summary estimates for CESM in the diagnosis of breast cancer were as follows: the pooled sensitivity and specificity were 0.89 (95% confidence interval [CI], 0.88-0.91) and 0.84 (95% CI, 0.82-0.85), respectively. Positive likelihood ratio was 3.73 (95% CI, 2.68-5.20), negative likelihood ratio was 0.10 (95% CI, 0.06-0.15), and diagnostic odds ratio was 71.36 (95% CI, 36.28-140.39). The area under the curve was 0.96 (standard error = 0.011). CONCLUSION CESM has a high diagnostic accuracy for evaluating breast cancer and can be considered as a useful test for initial assessment of breast lesions.
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Affiliation(s)
- Xiao Zhu
- Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, PR China
| | - Jun-Ming Huang
- Department of Oncology, Panyu Hospital of Chinese Medicine, Guangdong, PR China
| | - Kun Zhang
- Deparment of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong, PR China
| | - Long-Jie Xia
- Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, PR China
| | - Lan Feng
- National Center for Protein Sciences, Beijing, PR China
| | - Ping Yang
- Department of Oncology, Panyu Hospital of Chinese Medicine, Guangdong, PR China
| | - Meng-Ya Zhang
- Graduate School of Guangxi Medical University, Guangxi, PR China
| | - Wei Xiao
- Graduate School of Guangxi Medical University, Guangxi, PR China
| | - Hui-Xia Lin
- Graduate School of Guangxi Medical University, Guangxi, PR China
| | - Ying-Hua Yu
- Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, PR China.
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Gilbert FJ, Selamoglu A. Personalised screening: is this the way forward? Clin Radiol 2018; 73:327-333. [PMID: 29273223 DOI: 10.1016/j.crad.2017.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Screening with mammography has been implemented in many countries across the world with most offering 2-yearly examinations between the ages of 50-69 years. Robust modelling tools that include breast density and single nucleotide polymorphisms (SNPs) have been developed to predict which women are most likely to develop breast cancer. Mammographic sensitivity is poor in women with the densest category of breast tissue, and even women with heterogeneously dense tissue may benefit from additional supplemental imaging. Digital breast tomosynthesis (DBT), automated breast ultrasound (ABUS), contrast-enhanced mammography (CESM) or abbreviated (ABB) magnetic resonance imaging (MRI) all offer the opportunity to increase cancer detection, especially in women with dense breasts at increased risk of cancer. DBT increases cancer detection by around 15% with a corresponding reduction in recall rates; ABUS has been shown to increase cancer detection by between 2-4/1,000 depending on the cohort being examined and results in increased recalls, which tend to fall in subsequent screening rounds; CESM has very high sensitivity almost matching MRI with slightly improved specificity; ABB-MRI has been shown to be virtually equivalent to standard protocol MRI examinations, making this a technique that could be considered as a screening tool in high-risk women. This article reviews the literature to establish the current status of these techniques. The cost-effectiveness of these techniques requires further investigation and screening trials should report the nature of any additional tumours that are found.
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Affiliation(s)
- F J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
| | - A Selamoglu
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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Patel BK, Hilal T, Covington M, Zhang N, Kosiorek HE, Lobbes M, Northfelt DW, Pockaj BA. Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy. Ann Surg Oncol 2018. [DOI: 10.1245/s10434-018-6413-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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