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Ryser MD, Greenwald MA, Sorribes IC, King LM, Hall A, Geradts J, Weaver DL, Mallo D, Holloway S, Monyak D, Gumbert G, Vaez-Ghaemi S, Wu E, Murgas K, Grimm LJ, Maley CC, Marks JR, Shibata D, Hwang ES. Growth Dynamics of Ductal Carcinoma in Situ Recapitulate Normal Breast Development. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.01.560370. [PMID: 37873488 PMCID: PMC10592867 DOI: 10.1101/2023.10.01.560370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Ductal carcinoma in situ (DCIS) and invasive breast cancer share many morphologic, proteomic, and genomic alterations. Yet in contrast to invasive cancer, many DCIS tumors do not progress and may remain indolent over decades. To better understand the heterogenous nature of this disease, we reconstructed the growth dynamics of 18 DCIS tumors based on the geo-spatial distribution of their somatic mutations. The somatic mutation topographies revealed that DCIS is multiclonal and consists of spatially discontinuous subclonal lesions. Here we show that this pattern of spread is consistent with a new 'Comet' model of DCIS tumorigenesis, whereby multiple subclones arise early and nucleate the buds of the growing tumor. The discontinuous, multiclonal growth of the Comet model is analogous to the branching morphogenesis of normal breast development that governs the rapid expansion of the mammary epithelium during puberty. The branching morphogenesis-like dynamics of the proposed Comet model diverges from the canonical model of clonal evolution, and better explains observed genomic spatial data. Importantly, the Comet model allows for the clinically relevant scenario of extensive DCIS spread, without being subjected to the selective pressures of subclone competition that promote the emergence of increasingly invasive phenotypes. As such, the normal cell movement inferred during DCIS growth provides a new explanation for the limited risk of progression in DCIS and adds biologic rationale for ongoing clinical efforts to reduce DCIS overtreatment.
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Affiliation(s)
- Marc D. Ryser
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Mathematics, Duke University, Durham, NC, USA
| | | | | | - Lorraine M. King
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Allison Hall
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Joseph Geradts
- Department of Pathology, East Carolina University School of Medicine, Greenville, NC, USA
| | - Donald L. Weaver
- Larner College of Medicine, University of Vermont and UVM Cancer Center, Burlington, VT, USA
| | - Diego Mallo
- Arizona Cancer Evolution Center, Arizona State University, Tempe, AZ, USA
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Shannon Holloway
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Daniel Monyak
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Graham Gumbert
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | | | - Ethan Wu
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Kevin Murgas
- Department of Biomedical Informatics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Lars J. Grimm
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Carlo C. Maley
- Arizona Cancer Evolution Center, Arizona State University, Tempe, AZ, USA
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Jeffrey R. Marks
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Darryl Shibata
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - E. Shelley Hwang
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Nickel B, McCaffery K, Jansen J, Barratt A, Houssami N, Saunders C, Spillane A, Rutherford C, Stuart K, Robertson G, Dixon A, Hersch J. Women's views about current and future management of Ductal Carcinoma in Situ (DCIS): A mixed-methods study. PLoS One 2023; 18:e0288972. [PMID: 37478123 PMCID: PMC10361483 DOI: 10.1371/journal.pone.0288972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
Management of low-risk ductal carcinoma in situ (DCIS) is controversial, with clinical trials currently assessing the safety of active monitoring amidst concern about overtreatment. Little is known about general community views regarding DCIS and its management. We aimed to explore women's understanding and views about low-risk DCIS and current and potential future management options. This mixed-method study involved qualitative focus groups and brief quantitative questionnaires. Participants were screening-aged (50-74 years) women, with diverse socioeconomic backgrounds and no personal history of breast cancer/DCIS, recruited from across metropolitan Sydney, Australia. Sessions incorporated an informative presentation interspersed with group discussions which were audio-recorded, transcribed and analysed thematically. Fifty-six women took part in six age-stratified focus groups. Prior awareness of DCIS was limited, however women developed reasonable understanding of DCIS and the relevant issues. Overall, women expressed substantial support for active monitoring being offered as a management approach for low-risk DCIS, and many were interested in participating in a hypothetical clinical trial. Although some women expressed concern that current management may sometimes represent overtreatment, there were mixed views about personally accepting monitoring. Women noted a number of important questions and considerations that would factor into their decision making. Our findings about women's perceptions of active monitoring for DCIS are timely while results of ongoing clinical trials of monitoring are awaited, and may inform clinicians and investigators designing future, similar trials. Exploration of offering well-informed patients the choice of non-surgical management of low-risk DCIS, even outside a clinical trial setting, may be warranted.
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Affiliation(s)
- Brooke Nickel
- Faculty of Medicine and Health, Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Faculty of Medicine and Health, Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Alexandra Barratt
- Faculty of Medicine and Health, Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nehmat Houssami
- Faculty of Medicine and Health, Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Christobel Saunders
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Spillane
- Northern Clinical School, The University of Sydney, St Leonards, NSW, Australia
- Mater Hospital, Wollstonecraft, NSW, Australia
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Kirsty Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead, NSW, Australia
- Westmead Breast Cancer Institute, Westmead, NSW, Australia
- Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Ann Dixon
- Faculty of Science, Sydney Neuropsychology Clinic, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Jolyn Hersch
- Faculty of Medicine and Health, Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Hou R, Grimm LJ, Mazurowski MA, Marks JR, King LM, Maley CC, Lynch T, van Oirsouw M, Rogers K, Stone N, Wallis M, Teuwen J, Wesseling J, Hwang ES, Lo JY. Prediction of Upstaging in Ductal Carcinoma in Situ Based on Mammographic Radiomic Features. Radiology 2022; 303:54-62. [PMID: 34981975 DOI: 10.1148/radiol.210407] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Improving diagnosis of ductal carcinoma in situ (DCIS) before surgery is important in choosing optimal patient management strategies. However, patients may harbor occult invasive disease not detected until definitive surgery. Purpose To assess the performance and clinical utility of mammographic radiomic features in the prediction of occult invasive cancer among women diagnosed with DCIS on the basis of core biopsy findings. Materials and Methods In this Health Insurance Portability and Accountability Act-compliant retrospective study, digital magnification mammographic images were collected from women who underwent breast core-needle biopsy for calcifications that was performed at a single institution between September 2008 and April 2017 and yielded a diagnosis of DCIS. The database query was directed at asymptomatic women with calcifications without a mass, architectural distortion, asymmetric density, or palpable disease. Logistic regression with regularization was used. Differences across training and internal test set by upstaging rate, age, lesion size, and estrogen and progesterone receptor status were assessed by using the Kruskal-Wallis or χ2 test. Results The study consisted of 700 women with DCIS (age range, 40-89 years; mean age, 59 years ± 10 [standard deviation]), including 114 with lesions (16.3%) upstaged to invasive cancer at subsequent surgery. The sample was split randomly into 400 women for the training set and 300 for the testing set (mean ages: training set, 59 years ± 10; test set, 59 years ± 10; P = .85). A total of 109 radiomic and four clinical features were extracted. The best model on the test set by using all radiomic and clinical features helped predict upstaging with an area under the receiver operating characteristic curve of 0.71 (95% CI: 0.62, 0.79). For a fixed high sensitivity (90%), the model yielded a specificity of 22%, a negative predictive value of 92%, and an odds ratio of 2.4 (95% CI: 1.8, 3.2). High specificity (90%) corresponded to a sensitivity of 37%, positive predictive value of 41%, and odds ratio of 5.0 (95% CI: 2.8, 9.0). Conclusion Machine learning models that use radiomic features applied to mammographic calcifications may help predict upstaging of ductal carcinoma in situ, which can refine clinical decision making and treatment planning. © RSNA, 2022.
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Affiliation(s)
- Rui Hou
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Lars J Grimm
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Maciej A Mazurowski
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Jeffrey R Marks
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Lorraine M King
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Carlo C Maley
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Thomas Lynch
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Marja van Oirsouw
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Keith Rogers
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Nicholas Stone
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Matthew Wallis
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Jonas Teuwen
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Jelle Wesseling
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - E Shelley Hwang
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
| | - Joseph Y Lo
- From the Departments of Radiology (R.H., L.J.G., J.Y.L.) and Surgery (J.R.M., L.M.K., T.L., E.S.H.), Duke University Medical Center, Box 3513, Durham, NC 27710; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC (R.H.); School of Life Sciences, Arizona State University, Tempe, Ariz (C.C.M.); Cranfield Forensic Institute, Cranfield University, Cranfield, UK (K.R.); School of Physics and Astronomy, College of Engineering, Mathematics and Physical Sciences, Physics Building, Streatham Campus, University of Exeter, Exeter, UK (N.S.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Center, Cambridge University Hospitals NHS Trust, Cambridge Biomedical Campus, Cambridge, UK (M.W.); and Netherlands Cancer Institute, Amsterdam, the Netherlands (M.v.O., J.T., J.W.)
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