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Lyu S, Zhang M, Zhang B, Zhu J, Gao L, Qiu Y, Yang L, Zhang Y. The value of radiomics model based on ultrasound image features in the differentiation between minimal breast cancer and small benign breast masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1536-1543. [PMID: 37712556 DOI: 10.1002/jcu.23556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Female breast cancer has surpassed lung cancer as the most common cancer, and is also the main cause of cancer death for women worldwide. Breast cancer <1 cm showed excellent survival rate. However, the diagnosis of minimal breast cancer (MBC) is challenging. OBJECTIVE The purpose of our research is to develop and validate an radiomics model based on ultrasound images for early recognition of MBC. METHODS 302 breast masses with a diameter of <10 mm were retrospectively studied, including 159 benign and 143 malignant breast masses. The radiomics features were extracted from the gray-scale ultrasound image of the largest face of each breast mass. The maximum relevance minimum reduncancy and recursive feature elimination methods were used to screen. Finally, 10 features with the most discriminating value were selected for modeling. The random forest was used to establish the prediction model, and the rad-score of each mass was calculated. In order to evaluate the effectiveness of the model, we calculated and compared the area under the curve (AUC) value, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the model and three groups with different experience in predicting small breast masses, and drew calibration curves and decision curves to test the stability and consistency of the model. RESULTS When we selected 10 radiomics features to calculate the rad-score, the prediction efficiency was the best, the AUC values for the training set and testing set were 0.840 and 0.793, which was significantly better than the insufficient experience group (AUC = 0.673), slightly better than the moderate experience group (AUC = 0.768), and was inferior to the experienced group (AUC = 0.877). The calibration curve and decision curve also showed that the radiomics model had satisfied stability and clinical application value. CONCLUSION The radiomics model based on ultrasound image features has a satisfied predictive ability for small breast masses, and is expected to become a potential tool for the diagnosis of MBC, and it is a zero cost (in terms of patient participation and imaging time).
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Affiliation(s)
- Shuyi Lyu
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
- Department of Ultrasound, Zhenhai Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Meiwu Zhang
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
| | - Baisong Zhang
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
| | - Jiazhen Zhu
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
| | - Libo Gao
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
| | - Yuqin Qiu
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
| | - Liu Yang
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
| | - Yan Zhang
- Department of Ultrasound, Ningbo No. 2 Hospital, Zhejiang, China
- Department of Ultrasound, Zhenhai Hospital of Traditional Chinese Medicine, Zhejiang, China
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Li G, Tian H, Wu H, Huang Z, Yang K, Li J, Luo Y, Shi S, Cui C, Xu J, Dong F. Artificial intelligence for non-mass breast lesions detection and classification on ultrasound images: a comparative study. BMC Med Inform Decis Mak 2023; 23:174. [PMID: 37667320 PMCID: PMC10476370 DOI: 10.1186/s12911-023-02277-2] [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: 06/15/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND This retrospective study aims to validate the effectiveness of artificial intelligence (AI) to detect and classify non-mass breast lesions (NMLs) on ultrasound (US) images. METHODS A total of 228 patients with NMLs and 596 volunteers without breast lesions on US images were enrolled in the study from January 2020 to December 2022. The pathological results served as the gold standard for NMLs. Two AI models were developed to accurately detect and classify NMLs on US images, including DenseNet121_448 and MobileNet_448. To evaluate and compare the diagnostic performance of AI models, the area under the curve (AUC), accuracy, specificity and sensitivity was employed. RESULTS A total of 228 NMLs patients confirmed by postoperative pathology with 870 US images and 596 volunteers with 1003 US images were enrolled. In the detection experiment, the MobileNet_448 achieved the good performance in the testing set, with the AUC, accuracy, sensitivity, and specificity were 0.999 (95%CI: 0.997-1.000),96.5%,96.9% and 96.1%, respectively. It was no statistically significant compared to DenseNet121_448. In the classification experiment, the MobileNet_448 model achieved the highest diagnostic performance in the testing set, with the AUC, accuracy, sensitivity, and specificity were 0.837 (95%CI: 0.990-1.000), 70.5%, 80.3% and 74.6%, respectively. CONCLUSIONS This study suggests that the AI models, particularly MobileNet_448, can effectively detect and classify NMLs in US images. This technique has the potential to improve early diagnostic accuracy for NMLs.
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Affiliation(s)
- Guoqiu Li
- Jinan University, Guangzhou, Guangdong 510632 China
| | - Hongtian Tian
- Ultrasound Department, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, Guangdong 518020 China
| | - Huaiyu Wu
- Jinan University, Guangzhou, Guangdong 510632 China
- Ultrasound Department, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, Guangdong 518020 China
| | - Zhibin Huang
- Jinan University, Guangzhou, Guangdong 510632 China
| | - Keen Yang
- Jinan University, Guangzhou, Guangdong 510632 China
| | - Jian Li
- Ultrasound Department, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, Guangdong 518020 China
| | - Yuwei Luo
- Department of Thyroid and Breast Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, Guangdong 518020 China
| | - Siyuan Shi
- Research and development department, Illuminate, LLC, Shenzhen, Guangdong 518000 China
| | - Chen Cui
- Research and development department, Illuminate, LLC, Shenzhen, Guangdong 518000 China
| | - Jinfeng Xu
- Jinan University, Guangzhou, Guangdong 510632 China
- Ultrasound Department, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, Guangdong 518020 China
| | - Fajin Dong
- Jinan University, Guangzhou, Guangdong 510632 China
- Ultrasound Department, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, Guangdong 518020 China
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Izumori A, Kokubu Y. Ultrasound diagnosis of non-mass MRI-detected lesions. J Med Ultrason (2001) 2023; 50:351-360. [PMID: 37119448 PMCID: PMC10354149 DOI: 10.1007/s10396-023-01306-x] [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: 10/23/2022] [Accepted: 03/13/2023] [Indexed: 05/01/2023]
Abstract
Magnetic resonance imaging (MRI)-detected lesions are often category 2 or 3 lesions on initial ultrasound examination. In addition, in the case of new non-mass lesions detected on MRI, one would expect to find lesions with ductal dilatation with minimal secretory accumulation, single short lesions with ductal dilatation, cyst-like lesions less than 5 mm in size, mammary gland-like lesions less than 8 mm in size, and very indistinct lesions. Detection is expected to be even more difficult. Currently, there are no clear uniform criteria for the indication of second-look ultrasonography (US) for MRI-detected lesions, so it is not possible to make a general comparison, but recent studies have indicated that the ratio of mass to non-mass MRI-detected lesions is 7:3. And it has been pointed out that the percentage of malignancy is about 30% for each. Before about 2012, the US detection rate was about 70%, and MRI-guided biopsies of undetected lesions showed a small percentage of malignant lesions. Therefore, some observers believe that lesions not detected on US should be followed up, while others believe that MRI-guided biopsy should be performed. Recently, however, the use of surrounding anatomical structures as landmarks for second-look US has increased the detection rate to as high as 87-99%, and the percentage of malignancy remains the same. In addition, recent surveillance of high-risk breast cancer requires careful management of MRI-detected lesions. In this review, we will discuss the literature on MRI-detected lesions and describe ultrasound techniques to accurately detect small lesions and reliably reveal pale lesions based on their structural differences from their surroundings.
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Affiliation(s)
- Ayumi Izumori
- Department of Breast Surgery, Takamatsu Heiwa Hospital, Takamatsu, Japan.
| | - Yumi Kokubu
- Department of Ultrasound/IVR Diagnostic Imaging Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Ito T, Ueno E, Endo T, Omoto K, Kuwajima A, Taniguchi N, Tsunoda H, Tohno E, Hashimoto H, Fujimoto Y, Watanabe T. The Japan Society of Ultrasonics in Medicine guidelines on non-mass abnormalities of the breast. J Med Ultrason (2001) 2023; 50:331-339. [PMID: 37261555 PMCID: PMC10354171 DOI: 10.1007/s10396-023-01308-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 06/02/2023]
Abstract
It is possible to appropriately diagnose non-mass abnormalities by elucidating ultrasound non-mass abnormality findings and sharing the concept. If non-mass abnormalities can be diagnosed early, the number of curable cases could increase, leading to fewer breast cancer deaths. The Japan Society of Ultrasonics in Medicine (JSUM) Terminology/Diagnostic Criteria Committee has classified non-mass abnormalities into five subtypes: hypoechoic area in the mammary gland, abnormalities of the ducts, architectural distortion, multiple small cysts, and echogenic foci without a hypoechoic area. We herein define the findings for each of these subtypes and present a summary of the JSUM guidelines on non-mass abnormalities of the breast generated based on those findings.
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Affiliation(s)
- Toshikazu Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan.
| | - Ei Ueno
- Tsukuba International Breast Clinic, Ibaraki, Japan
| | - Tokiko Endo
- Department of Breast Surgery, National Hospital Organization Higashinagoya National Hospital, Aichi, Japan
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akira Kuwajima
- Department of Health Check-Up, PL Tokyo Health Control Center, Tokyo, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiroko Tsunoda
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, Ibaraki, Japan
| | - Hideyuki Hashimoto
- Medical Department, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | | | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Miyagi, Japan
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Watanabe T. Features of ductal carcinoma in situ ultrasound images. J Med Ultrason (2001) 2023; 50:347-350. [PMID: 37369884 PMCID: PMC10354177 DOI: 10.1007/s10396-023-01334-7] [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: 10/20/2022] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Ultrasound images of ductal carcinoma in situ (DCIS) show a wide range of variations from mass to non-mass lesions. This article describes the characteristics of ultrasound images of DCIS based on the BC-02 study conducted by The Japanese Association of Breast and Thyroid Sonology (JABTS). In the BC-02 study, ultrasound images of 705 DCIS cases were classified by imaging findings. The results showed that non-mass abnormalities accounted for 60% of all lesions and masses for 40%. Looking at each subclassification, hypoechoic areas in the mammary gland were the most common (50% of the total), followed by solid masses (31%), mixed masses (9%), and abnormalities of the ducts (8%). These four classifications accounted for 98% of the total. Echogenic foci without a hypoechoic area, architectural distortion, and clustered microcysts were very rare, accounting for about 1% of the total. The ultrasound images of DCIS were characterized by a wide range of variations from masses to non-masses abnormalities, with hypoechoic areas in the mammary gland being the most common, followed by solid masses.
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Affiliation(s)
- Takanori Watanabe
- National Hospital Organization Sendai Medical Center, 2-11-12 Miyaginohara, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
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Guo W, Wang T, Li F, Jia C, Zheng S, Zhang X, Bai M. Non-mass Breast Lesions: Could Multimodal Ultrasound Imaging Be Helpful for Their Diagnosis? Diagnostics (Basel) 2022; 12:diagnostics12122923. [PMID: 36552930 PMCID: PMC9777234 DOI: 10.3390/diagnostics12122923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To develop a prediction model for discriminating malignant from benign breast non-mass-like lesions (NMLs) using conventional ultrasound (US), strain elastography (SE) of US elastography and contrast-enhanced ultrasound (CEUS). Methods: A total of 101 NMLs from 100 patients detected by conventional US were enrolled in this retrospective study. The characteristics of NMLs in conventional US, SE and CEUS were compared between malignant and benign NMLs. Histopathological results were used as the reference standard. Binary logistic regression analysis was performed to identify the independent risk factors. A multimodal method to evaluate NMLs based on logistic regression was developed. The diagnostic performance of conventional US, US + SE, US + CEUS and the combination of these modalities was evaluated and compared. Results: Among the 101 lesions, 50 (49.5%) were benign and 51 (50.5%) were malignant. Age ≥45 y, microcalcifications in the lesion, elasticity score >3, earlier enhancement time and hyper-enhancement were independent diagnostic indicators included to establish the multimodal prediction method. The area under the receiver operating characteristic curve (AUC) of US + SE + CEUS was significantly higher than that of US (p < 0.0001) and US + SE (p < 0.0001), but there was no significant difference between the AUC of US + SE + CEUS and the AUC of US + CEUS (p = 0.216). Conclusion: US + SE + CEUS and US + CEUS could significantly improve the diagnostic efficiency and accuracy of conventional US in the diagnosis of NMLs.
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Affiliation(s)
- Wenjuan Guo
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Tong Wang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Siqi Zheng
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xuemei Zhang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
- Correspondence:
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Moschetta M, Sardaro A, Nitti A, Telegrafo M, Maggialetti N, Scardapane A, Brunese MC, Lavelli V, Ferrari C. Ultrasound evaluation of ductal carcinoma in situ of the breast. J Ultrasound 2021; 25:41-45. [PMID: 33409862 PMCID: PMC8964906 DOI: 10.1007/s40477-020-00551-x] [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: 10/08/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the role of ultrasound (US) in detecting and characterizing ductal carcinoma in situ (DCIS) of the breast and to investigate the correlation between ultrasonographic and biological features of DCIS. METHODS In total, 171 patients (mean age 44; range 39-62) with 178 lesions were retrospectively evaluated by two independent radiologists searching for US mass or non-mass lesions. Immunohistochemistry analysis was performed to determine estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. The US detection rate and pattern distribution among the lesion types were evaluated. The χ2 test was used to evaluate the correlation between the US findings and the biological factors. Statistical significance was indicated by p values < 0.05. Inter-observer agreement was calculated by Kohen's k test. RESULTS US detected 35% (63/178) of all lesions. Fifty-two (83%) lesions were classified as mass lesions, and 11 (17%) as non-mass lesions (p < 0.0001). Among the mass lesions, the most common shape was irregular (79%; p < 0.0001), with 45 (87%) lesions having indistinct margins. Hypoechogenicity was the most common echo pattern (49 cases, 94%; p < 0.0001). Microcalcifications were found in 23 cases (37%; p = 0.004) and were associated with mass lesions in 15 cases (65%) and with non-mass lesions in 8 cases (35%) (p = 0.21). An almost perfect inter-observer agreement (k = 0.87) was obtained between the two radiologists. A significant ER expression was found in mass lesions (83%; p < 0.0001), with no significant PR (p = 0.89) or HER2 expression (p = 0.81). Among the lesions with microcalcifications, only 7 out of 23 cases (30%) were positive for HER2 (p = 0.09). CONCLUSION DCIS represents a heterogeneous pathological process with variable US appearance (mass-like, non-mass-like, or occult). The most common US finding is represented by mass-type, hypoechogenic lesions with indistinct margins. A significant ER expression exists among mass-type lesions, while microcalcifications seem not to be associated with HER2 expression.
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Affiliation(s)
- Marco Moschetta
- DETO, Department of Emergency and Organ Transplantations, Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Angela Sardaro
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Adriana Nitti
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Michele Telegrafo
- grid.7644.10000 0001 0120 3326DETO, Department of Emergency and Organ Transplantations, Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Maggialetti
- grid.10373.360000000122055422Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Arnaldo Scardapane
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Maria Chiara Brunese
- grid.10373.360000000122055422Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Nuclear Medicine, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Nuclear Medicine, Aldo Moro University of Bari Medical School, Bari, Italy
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Li JK, Wang HF, He Y, Huang Y, Liu G, Wang ZL. Ultrasonographic features of ductal carcinoma in situ: analysis of 219 lesions. Gland Surg 2020; 9:1945-1954. [PMID: 33447545 DOI: 10.21037/gs-20-428] [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: 11/06/2022]
Abstract
Background The purpose of this paper is to clarify the ultrasonographic features and classification of ductal carcinoma in situ (DCIS), and to evaluate the ability of ultrasonography in the prediction of DCIS. Methods The clinical data, gray-scale ultrasound images and pathological results of 219 DCIS lesions that detected in 203 consecutive patients who underwent ultrasonography and surgery in our hospital from January 1, 2014 to December 31, 2019 were collected retrospectively. Ultrasonographic features and classification of DCIS were summarized, and the accuracy of ultrasonography in predicting different ultrasonographic findings of DCIS were compared. Results Among the 219 DCIS lesions, 91 (41.6%) presented as mass-like lesions and 128 (58.4%) were non-mass-like lesions. For the 91 mass-like DCIS lesions, 79 were hypoechoic solid masses, 12 were cystic-solid structures. For the 128 non-mass-like DCIS lesions, 114 were hypoechoic areas, 10 were ductal dilatation accompanied with intraductal solid components, and 4 were multiple punctate echogenic foci only. The diagnostic accuracy of ultrasound for the 219 DCIS lesions was 81.7% (179/219). The diagnostic accuracy of mass-like DCIS lesions was 90.1% (82/91), which was significantly higher than that in non-mass-like DCIS lesions [75.8% (97/128), P=0.007]. The diagnostic accuracy of hypoechoic solid masses was significantly higher than those of the other ultrasonographic findings (P=0.002). Ducts abnormalities were detected in 45 (20.5%) lesions and punctate echogenic foci in 134 (61.2%) lesions. The diagnostic accuracy of lesions with ducts abnormalities was 93.3% (42/45), which was significantly higher than that in lesions without ducts abnormalities [78.7% (137/174), P=0.024]. The diagnostic accuracy of lesions with punctate echogenic foci was 92.5% (124/134), which was significantly higher than that in lesions without punctate echogenic foci [64.7% (55/85), P=0.000]. Conclusions DCIS lesions can effectively be recognized as mass-like lesions and non-mass-like lesions by ultrasound. Hypoechoic areas and hypoechoic solid masses were the most common ultrasonographic features of DCIS. Ducts abnormalities and punctate echogenic foci were helpful for the diagnosis of DCIS.
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Affiliation(s)
- Jun Kang Li
- Department of Ultrasound, Chinese People's Liberation Army 63820 Hospital, Mianyang, China
| | - Huan Fan Wang
- Department of Ultrasound, Second Affiliated Hospital of Xingtai Medical College, Xingtai, China
| | - Yan He
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yong Huang
- Department of Pathology, Chinese People's Liberation Army 63820 Hospital, Mianyang, China
| | - Gang Liu
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhi Li Wang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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9
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Ban K, Tsunoda H, Watanabe T, Kaoku S, Yamaguchi T, Ueno E, Hirokaga K, Tanaka K. Characteristics of ultrasonographic images of ductal carcinoma in situ with abnormalities of the ducts. J Med Ultrason (2001) 2019; 47:107-115. [PMID: 31655940 PMCID: PMC6971153 DOI: 10.1007/s10396-019-00981-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/19/2019] [Indexed: 11/15/2022]
Abstract
Purpose Although the number of ductal carcinoma in situ (DCIS) cases has increased with the spread of breast cancer screening in Japan, there are very few reports that summarize ultrasound image features of DCIS. The Japan Association of Breast and Thyroid Sonology (JABTS) investigated the incidence of DCIS with masses and non-mass abnormalities and the characteristics of US images in a retrospective, multicenter, observational study (JABTS BC-02 study). The purpose of this report is to clarify the proportion of DCIS with abnormalities of the ducts with each ultrasound finding and the characteristics of US images. Methods The JABTS BC-02 study population was comprised of patients who were examined by ultrasonography, underwent surgery, and were histopathologically diagnosed with DCIS at each study site between January 2008 and December 2012. The US images of DCIS and pathology and clinical information were retrospectively collected from 16 institutions in Japan. The US images were evaluated by 22 experts on the Central Image Interpretation Committee of JABTS. Results Abnormalities of the ducts were noted in 78 (10.5%) of 705 US images of DCIS. Of the 78 cases, the distribution of abnormalities of the ducts was focal or segmental. The second characteristic was the presence of internal echoes in dilated ducts. All cases were accompanied by intraductal solid echoes, and 40 cases (51.3%) were accompanied by echogenic foci. In addition, intraductal solid echoes were continuous or multiple in 72 cases (92.4%), and the shape of the solid echoes was broad-based and/or irregular in 62 cases (79.5%). Conclusion DCIS cases with duct abnormalities on ultrasound were investigated in this study. The important characteristics were as follows: (1) the distribution of ductal dilatation was focal or segmental, (2) solid parts were present in the dilated ducts, (3) the distribution of internal echoes was continuous or multiple, (4) the shape of solid echoes was broad-based and/or irregular, and (5) internal echoes were sometimes accompanied by echogenic foci. Accurate evaluation of these findings may be useful for diagnosing DCIS. Although the duct abnormalities are included in “ASSOCIATED FEATURES” in ACR BI-RADS ATLAS (USA), we emphasize that this concept is very important for understanding US characteristics of DCIS.
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Affiliation(s)
- Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, 1-2 Ichigaya-Sadohara-cho, Shinjuku-ku, Tokyo, 162-8402, Japan.
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Setsuko Kaoku
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takuhiro Yamaguchi
- Clinical Research Data Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Ei Ueno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Kumiko Tanaka
- Department of Breast Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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10
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Shehata M, Grimm L, Ballantyne N, Lourenco A, Demello LR, Kilgore MR, Rahbar H. Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment. JOURNAL OF BREAST IMAGING 2019; 1:166-176. [PMID: 31538141 DOI: 10.1093/jbi/wbz039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/27/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.
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Affiliation(s)
- Mariam Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA
| | - Lars Grimm
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Nancy Ballantyne
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Ana Lourenco
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Linda R Demello
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Mark R Kilgore
- University of Washington School of Medicine, Department of Anatomic Pathology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
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Ductal Carcinoma In Situ Management: All or Nothing, or Something in between? CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fowler AM. Survival Outcomes for Women with Ductal Carcinoma in Situ in the Era of Supplemental Screening. Radiology 2019; 292:49-50. [DOI: 10.1148/radiol.2019190762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amy M. Fowler
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; University of Wisconsin Carbone Cancer Center, Madison, Wis; and Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Choi SH, Choi JS, Han BK, Ko EY, Ko ES, Park KW. Long-term Surveillance of Ductal Carcinoma in Situ Detected with Screening Mammography versus US: Factors Associated with Second Breast Cancer. Radiology 2019; 292:37-48. [PMID: 31038406 DOI: 10.1148/radiol.2019181844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The relationship between method of breast cancer screening (mammography or US) and survival outcome in patients with screening-detected ductal carcinoma in situ (DCIS) has not been determined. Purpose To investigate whether different methods of breast cancer screening are associated with different survival outcomes in patients with screening-detected DCIS and to evaluate clinical-pathologic and imaging factors associated with second breast cancer. Materials and Methods We retrospectively identified women who underwent surgery to treat DCIS initially detected with screening mammography or US between July 2004 and December 2011 in a single institution. Overall survival (OS) and disease-free survival (DFS) were assessed. Factors associated with second breast cancer (invasive carcinoma or DCIS) were found with multivariable Cox proportional hazards regression analysis. Subgroups were analyzed according to screening method. Results A total of 814 women (median age, 47 years; age range, 25-81 years) were included; 627 underwent treatment for screening mammography-detected DCIS (mammography-detected group), and 187 underwent treatment for screening US-detected DCIS (US-detected group). During follow-up (median, 7 years; interquartile range, 5-8 years), 26 ipsilateral and 26 contralateral second breast cancers (6.4%, 52 of 814) were found, with 44 in the mammography-detected group and eight in the US-detected group. The overall 5-year OS and DFS rates were 100% and 95.3%, respectively. DFS rates did not differ according to screening method (P = .21, 5-year DFS rates were 94.9% in the mammography-detected group and 96.5% in the US-detected group). In the mammography-detected group, higher nuclear grade (intermediate grade: hazard ratio [HR], 5.7; 95% confidence interval [CI]: 1.3, 24.3; P = 0.02) (high grade: HR, 8.0; 95% CI: 1.9, 34.2; P = .01) and dense breast (HR, 3.5; 95% CI: 1.1, 11.4; P = 0.04) were associated with second breast cancer. In the US-detected group, human epidermal growth factor receptor 2 positivity was associated with second breast cancer (HR, 9.2; 95% CI: 2.2, 38.5; P = .002). Conclusion Disease-free survival of patients who underwent treatment for screening-detected ductal carcinoma in situ (DCIS) did not differ according to screening detection method. In patients with screening mammography-detected DCIS, higher nuclear grade and dense breast were associated with second breast cancer, and in patients with screening US-detected DCIS, human epidermal growth factor 2 positivity was associated with second breast cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Fowler in this issue.
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Affiliation(s)
- Seung Hee Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ji Soo Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Boo-Kyung Han
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Eun Young Ko
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Eun Sook Ko
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ko Woon Park
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Cha H, Chang YW, Lee EJ, Hwang JY, Kim HJ, Lee EH, Ryu JK. Ultrasonographic features of pure ductal carcinoma in situ of the breast: correlations with pathologic features and biological markers. Ultrasonography 2017; 37:307-314. [PMID: 29169230 PMCID: PMC6177689 DOI: 10.14366/usg.17039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/13/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic features of pure ductal carcinoma in situ (DCIS) of the breast and to evaluate the correlations of ultrasonographic features with pathologic and biological features. Methods A total of 141 lesions in 138 women with pure DCIS who underwent preoperative breast ultrasonography were retrospectively reviewed. Ultrasonographic features were analyzed using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon and the diagnostic criteria of the Japan Society of Ultrasonics in Medicine. Pathologic features including the nuclear grade and presence of comedonecrosis were evaluated. Biological markers including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, as well as the Ki-67 index, were recorded. Ultrasonographic features were compared with pathologic findings and biological markers using the chi-square test. P-values of <0.05 were considered to indicate statistical significance. Results Of the 141 lesions, 75 (53.2%) were mass lesions, 56 (39.7%) were non-mass lesions, and 10 (7.1%) were not visible. The most common feature of the mass pattern was a mass with irregular shape (32.6%), an indistinct margin (27.7%), and hypoechogenicity (37.6%). Microcalcifications were observed in 48 cases (36.6%) as an associated feature. Calcifications outside of a mass were more common than calcifications within a mass. Ultrasonographic microcalcifications and ductal changes were frequently observed in non-mass lesions. Ultrasonographic non-mass lesions were associated with high-grade DCIS (P=0.004) and the presence of comedonecrosis (P=0.006). Microcalcifications were significantly associated with high-grade DCIS (P<0.001), the presence of comedonecrosis (P<0.001), an elevated Ki-67 (P<0.001), and HER2 positivity (P=0.003). Conclusion The most common ultrasonographic feature of pure DCIS was an irregular, hypoechoic mass with an indistinct margin. Ultrasonographic microcalcifications and ductal changes were more frequent in non-mass lesions, which were correlated with poor prognostic factors, such as a high nuclear grade, comedonecrosis, HER2 positivity, and an elevated Ki-67 index.
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Affiliation(s)
- Hwajin Cha
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ji Young Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung Kyu Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Watanabe T, Yamaguchi T, Tsunoda H, Kaoku S, Tohno E, Yasuda H, Ban K, Hirokaga K, Tanaka K, Umemoto T, Okuno T, Fujimoto Y, Nakatani S, Ito J, Ueno E. Ultrasound Image Classification of Ductal Carcinoma In Situ (DCIS) of the Breast: Analysis of 705 DCIS Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:918-925. [PMID: 28242086 DOI: 10.1016/j.ultrasmedbio.2017.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 06/06/2023]
Abstract
The Japan Association of Breast and Thyroid Sonology (JABTS) proposed, in 2003, a conceptual classification system for non-mass abnormalities to be applied in addition to the conventional concept of masses, to facilitate detecting ductal carcinoma in situ (DCIS) lesions. The aim of this study was to confirm the utility of this system and to clarify the distribution of these findings in DCIS lesions. Data on 705 surgically treated DCIS lesions from 16 institutions in Japan were retrospectively reviewed. All 705 DCIS lesions could be classified according to the JABTS classification system. The most frequent findings were hypo-echoic areas in the mammary gland (48.6%), followed by solid masses (28.0%) and duct abnormalities (10.2%) or mixed masses (8.1%). Distortion (1.3%), clustered microcysts (1.4%) and echogenic foci without a hypo-echoic area (2.5%) were uncommon. These results suggest that the concept of non-mass abnormalities is useful in detecting DCIS lesions.
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Affiliation(s)
- Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
| | - Takuhiro Yamaguchi
- Clinical Research Data Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Setsuko Kaoku
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Hidemitsu Yasuda
- Department of Breast Surgery, National Center for Global Health and Medicine, Shinjuku-Ku, Tokyo, Japan
| | - Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, Shinjuku-ku, Tokyo, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Kumiko Tanaka
- Breast Surgery, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Takeshi Umemoto
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Toshitaka Okuno
- Breast Surgery, Nishi-kobe Medical Center, Nishi-ku, Kobe City, Japan
| | | | - Shuichi Nakatani
- Department of Breast Surgery, Minami Osaka General Hospital, Higashi-Kagaya Suminoe-ku, Osaka City, Japan
| | - Jun Ito
- Department of Surgery I, Dokkyo Medical University, Mibu-Machi, Tochigi, Japan
| | - Ei Ueno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
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Cho KR, Seo BK, Woo OH, Song SE, Choi J, Whang SY, Park EK, Park AY, Shin H, Chung HH. Breast Cancer Detection in a Screening Population: Comparison of Digital Mammography, Computer-Aided Detection Applied to Digital Mammography and Breast Ultrasound. J Breast Cancer 2016; 19:316-323. [PMID: 27721882 PMCID: PMC5053317 DOI: 10.4048/jbc.2016.19.3.316] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We aimed to compare the detection of breast cancer using full-field digital mammography (FFDM), FFDM with computer-aided detection (FFDM+CAD), ultrasound (US), and FFDM+CAD plus US (FFDM+CAD+US), and to investigate the factors affecting cancer detection. Methods In this retrospective study conducted from 2008 to 2012, 48,251 women underwent FFDM and US for cancer screening. One hundred seventy-one breast cancers were detected: 115 invasive cancers and 56 carcinomas in situ. Two radiologists evaluated the imaging findings of FFDM, FFDM+CAD, and US, based on the Breast Imaging Reporting and Data System lexicon of the American College of Radiology by consensus. We reviewed the clinical and the pathological data to investigate factors affecting cancer detection. We statistically used generalized estimation equations with a logit link to compare the cancer detectability of different imaging modalities. To compare the various factors affecting detection versus nondetection, we used Wilcoxon rank sum, chi-square, or Fisher exact test. Results The detectability of breast cancer by US (96.5%) or FFDM+CAD+US (100%) was superior to that of FFDM (87.1%) (p=0.019 or p<0.001, respectively) or FFDM+ CAD (88.3%) (p=0.050 or p<0.001, respectively). However, cancer detectability was not significantly different between FFDM versus FFDM+CAD (p=1.000) and US alone versus FFDM+CAD+US (p=0.126). The tumor size influenced cancer detectability by all imaging modalities (p<0.050). In FFDM and FFDM+CAD, the nondetecting group consisted of younger patients and patients with a denser breast composition (p<0.050). In breast US, carcinoma in situ was more frequent in the nondetecting group (p=0.014). Conclusion For breast cancer screening, breast US alone is satisfactory for all age groups, although FFDM+ CAD+US is the perfect screening method. Patient age, breast composition, and pathological tumor size and type may influence cancer detection during screening.
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Affiliation(s)
- Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jungsoon Choi
- Department of Mathematics, School of Natural Sciences, Hanyang University, Seoul, Korea
| | - Shin Young Whang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Kyung Park
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyeseon Shin
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Choi JS, Han BK, Ko EY, Ko ES, Shin JH, Kim GR. Additional diagnostic value of shear-wave elastography and color Doppler US for evaluation of breast non-mass lesions detected at B-mode US. Eur Radiol 2016; 26:3542-9. [PMID: 26787603 DOI: 10.1007/s00330-015-4201-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/08/2015] [Accepted: 12/30/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of shear-wave elastography (SWE) and colour Doppler ultrasound (US) for evaluation of breast non-mass lesions (NMLs) detected by B-mode US. METHODS This retrospective study enrolled 116 NMLs (42 benign, 74 malignant). For each lesion, B-mode US, SWE and colour Doppler US were performed. Mean elasticity (E mean), maximum elasticity (E max) and vascularity were assessed by SWE and Doppler US. Diagnostic performances of B-mode US, SWE and Doppler US were calculated to differentiate benign and malignant NMLs. RESULTS In benign NMLs, average E mean and E max were lower, and low vascularity (no flow or only one vessel flow) was more frequent (P < 0.001). When BI-RADS category 4a NMLs were downgraded to category 3 with 'E mean of 85.1 kPa or less' and/or 'low vascularity', specificities increased (69.0-90.5 %; P < 0.001), without significant loss in sensitivities (97.3-100 %). When these 4a NMLs were downgraded by the combination of SWE and Doppler US, all downgraded NMLs (59.3 %, 19/32) were confirmed as benign. CONCLUSIONS Addition of SWE and colour Doppler US to B-mode US improved diagnostic performances in differentiating benign and malignant NMLs. This study suggests that the combination of SWE and colour Doppler may help patients with BI-RADS category 4a NMLs avoid unnecessary biopsies. KEY POINTS • B-mode US features of malignant and benign NMLs may overlap. • SWE and colour Doppler provides useful information about breast NMLs. • SWE and colour Doppler may decrease unnecessary biopsies of breast NMLs.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Boo-Kyung Han
- Department of Radiology, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea.
| | - Eun Young Ko
- Department of Radiology, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Eun Sook Ko
- Department of Radiology, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Jung Hee Shin
- Department of Radiology, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Ga Ram Kim
- Department of Radiology, Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
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Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR Am J Roentgenol 2015; 204:878-88. [PMID: 25794082 DOI: 10.2214/ajr.13.12221] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of our study was to compare the sonographic features of pure ductal carcinoma in situ (DCIS) lesions with the initial clinical presentation and histopathologic findings. MATERIALS AND METHODS The images and records of 691 patients with pure DCIS who underwent preoperative mammography and whole-breast sonography as part of staging workup in a single institution from January 1, 1996, through July 31, 2009, were reviewed. The BI-RADS sonography lexicon was used when reviewing the sonographic studies. Histopathologic features recorded included estrogen receptor (ER) status, nuclear grade, and presence or absence of comedonecrosis. Statistical comparisons were made using the Student t test, chi-square test, Fisher exact test, Kruskal-Wallis or Wilcoxon rank sum test, multiple logistic regression analysis, and Pearson correlation coefficient. RESULTS A total of 304 (44%) tumors were visible on mammography and sonography; 315 (46%), on mammography only; 58 (8%), on sonography only; and 14 (2%), on neither mammography nor sonography. The most common sonographic appearance of DCIS was an irregular hypoechoic mass with indistinct margins and normal posterior features that was indistinguishable from invasive carcinoma. Patients with symptomatic high-nuclear-grade DCIS, dense breasts, and comedonecrosis were younger and had larger tumors on sonography than asymptomatic women with nondense breasts and low-nuclear-grade and noncomedo DCIS. Women with ER-negative DCIS were older and had larger tumors on sonography than women with ER-positive DCIS. ER-negative tumors were more frequently visible on sonography than ER-positive tumors (p=0.007). High-grade DCIS (p<0.0001) and comedo DCIS (p<0.0001) presented more frequently as microcalcifications, architectural distortion, and ductal changes on sonography than low-grade DCIS or noncomedo DCIS. CONCLUSION Of the 691 pure DCIS lesions, 362 (52%) were visible on sonography and presented most commonly as a mass. Lesion visibility of DCIS on sonography was not related to nuclear grade or the presence of comedonecrosis.
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Jin ZQ, Lin MY, Hao WQ, Jiang HT, Zhang L, Hu WH, Zhang M. Diagnostic evaluation of ductal carcinoma in situ of the breast: ultrasonographic, mammographic and histopathologic correlations. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:47-55. [PMID: 25479813 DOI: 10.1016/j.ultrasmedbio.2014.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 06/04/2023]
Abstract
The aims of the study described here were to illustrate the spectrum of ultrasonographic features of ductal carcinoma in situ (DCIS) and to evaluate the ability of ultrasonography (US) to predict the grade and recurrence of DCIS on the basis of mammographic and histopathologic findings. We retrospectively evaluated the ultrasonographic features of 129 DCIS lesions from 127 consecutive women and compared these with their mammographic and histopathologic features. The mean size of DCISs on ultrasonography and mammography (MMG) was 3.67 ± 1.40 and 4.00 ± 1.74 cm, respectively, which do not differ statistically (p = 0.09). Despite the statistical difference in Breast Imaging Reporting and Data System (BI-RADS) classification on US and MMG (p = 0.000), the median BI-RADS classification is category 4c on both US and MMG (p = 0.01). There was no statistically significant difference in the distribution of microcalcification on MMG and US. Clusters <5 mm in greatest diameter are easily seen on MMG. At US, a scattered/linear distribution on MMG had a higher level of visibility than clustered distribution on MMG. The correlation between tumor size and DCIS with micro-invasion evaluated using US is higher than that obtained using MMG (p = 0.001 and 0.024, respectively). When US was used for the detection of DCIS, diagnostic accuracy was significantly associated with higher Van Nuys groups, the presence of micro-invasion and comedo carcinoma (p = 0.000, 0.022 and 0.011, respectively). However, mammographic diagnostic accuracy was found not to associate with higher Van Nuys groups, the presence of micro-invasion and comedo carcinoma (p = 0.054, 0.093 and 0.256, respectively). Ultrasonography may play an important role both in detecting DCIS and in evaluating its histopathologic features. Detection of DCIS using MMG alone may be suboptimal for patients with dense breasts, especially among Chinese women.
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Affiliation(s)
- Zhan-Qiang Jin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China.
| | - Mei-Ying Lin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Wan-Qing Hao
- Department of Radiology, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Hua-Tang Jiang
- Department of Radiology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Li Zhang
- Department of Ultrasound, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Wen-Hua Hu
- Department of Pathology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Miao Zhang
- Department of Pathology, Ningxia People's Hospital, Yinchuan, Ningxia, China
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Fleury EDFC, Assunção-Queiros MDCGA, Roveda D. Breast carcinomas: variations in sonoelastographic appearance. BREAST CANCER-TARGETS AND THERAPY 2014; 6:135-43. [PMID: 25177152 PMCID: PMC4128690 DOI: 10.2147/bctt.s66110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background This study assessed factors influencing the sonoelastographic presentation of breast carcinoma. Methods A prospective collaborative study was conducted by the Santa Casa de São Paulo and CTC-Center, on 540 breast lesions in women referred for percutaneous breast biopsy. Eighty-four carcinomas showing lesions on ultrasonography were included. These lesions were classified into four sonoelastographic scores, where scores of 1, 2, and 3 were considered false-negative, and a score of 4 was considered true-positive. Scores were compared against histopathologic results, which were divided into two groups, ie, soft lesions (group 1) and hard lesions (group 2). False-negative and true-positive results were also assessed for variation according to patient age and mean lesion diameter. Results Of the 84 lesions studied, nine yielded false-negative results on sonoelastography and 75 yielded true-positive results. In terms of histopathologic classification, eight were assigned to group 1 and 76 to group 2. The chi-squared test showed a correlation between sonoelastographic scores and histopathologic lesion type. No statistically significant differences were observed according to patient age or largest lesion diameter. Conclusion Our results revealed an association between sonoelastographic presentation of breast lesions and histology. False-negative results on sonoelastography were influenced by histologic type of lesion and not by lesion size or patient age.
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Affiliation(s)
| | | | - Decio Roveda
- Faculdade de Cências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
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Omranipour R, Alipour S, Hadji M, Bagheri K. Two Decades of Experience with Ductal Carcinoma in Situ of the Breast in the Cancer Institute of Tehran, Iran. Asian Pac J Cancer Prev 2014; 15:2771-6. [DOI: 10.7314/apjcp.2014.15.6.2771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Ultrasonography (US) is an indispensable tool in breast imaging and is complementary to both mammography and magnetic resonance (MR) imaging of the breast. Advances in US technology allow confident characterization of not only benign cysts but also benign and malignant solid masses. Knowledge and understanding of current and emerging US technology, along with the application of meticulous scanning technique, is imperative for image optimization and diagnosis. The ability to synthesize breast US findings with multiple imaging modalities and clinical information is also necessary to ensure the best patient care. US is routinely used to guide breast biopsies and is also emerging as a supplemental screening tool in women with dense breasts and a negative mammogram. This review provides a summary of current state-of-the-art US technology, including elastography, and applications of US in clinical practice as an adjuvant technique to mammography, MR imaging, and the clinical breast examination. The use of breast US for screening, preoperative staging for breast cancer, and breast intervention will also be discussed.
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Affiliation(s)
- Regina J Hooley
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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Potential role of shear-wave ultrasound elastography for the differential diagnosis of breast non-mass lesions: preliminary report. Eur Radiol 2013; 24:305-11. [PMID: 24081648 DOI: 10.1007/s00330-013-3034-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/31/2013] [Accepted: 09/14/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To report our preliminary experience with shear-wave elastography (SWE) for non-mass lesions (NMLs) in the breast and suggest a potential ancillary role of SWE for BI-RADS Category 4a NMLs in reducing the number of unnecessary benign biopsies. METHODS A total of 310 breast lesions in 286 consecutive women who had been scheduled for US-guided automated gun biopsy or vacuum-assisted biopsy between June and December 2012 were initially included in this study. Finally, 33 women with 34 breast lesions classified as NMLs constituted our study population. Diagnostic performances of each quantitative SWE parameter were calculated. Histological diagnosis was used as a reference standard. RESULTS Among the 34 breast NMLs, 22 (65%) were benign and 12 (35%) were malignant. Emean value with cut-off set at 41.6 kPa had the highest Az value 0.788 (95% CI, 0.625-0.951), showing sensitivity of 83.3% and specificity of 68.2%. By applying an Emean value of 41.6 kPa or less as a criterion for downgrading soft BI-RADS category 4a NMLs to category 3 NMLs, 15 unnecessary biopsies could have been eliminated from the 19 BI-RADS category 4a lesions (79%). CONCLUSIONS SWE features could increase positive predictive values and reduce unnecessary benign biopsies of category 4a NMLs. KEY POINTS • Ultrasound elastography is increasingly used to assess the stiffness of breast lesions • Shear-wave elastography provides useful information about non-mass breast lesions • Shear-wave elastography may render some biopsies of non-mass breast lesions unnecessary.
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Wang LC, Sullivan M, Du H, Feldman MI, Mendelson EB. US Appearance of Ductal Carcinoma in Situ. Radiographics 2013; 33:213-28. [DOI: 10.1148/rg.331125092] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Shin HC, Han W, Moon HG, Yom CK, Ahn SK, You JM, Kim JS, Chang JM, Cho N, Moon WK, Park IA, Noh DY. Limited Value and Utility of Breast MRI in Patients Undergoing Breast-Conserving Cancer Surgery. Ann Surg Oncol 2012; 19:2572-9. [DOI: 10.1245/s10434-012-2289-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Indexed: 11/18/2022]
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A prospective study about abnormal ductal dilatations without associated masses on breast US: what is the significance for us? Acad Radiol 2012; 19:296-302. [PMID: 22173322 DOI: 10.1016/j.acra.2011.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Ductal changes are described as a finding of surrounding tissues in breast masses according to the Breast Imaging Reporting and Data System - Ultrasound. However, ductal changes are often found as an isolated finding without a mass on ultrasound. The purpose of this study was to investigate the clinical significance of abnormal ductal dilatations without masses on breast ultrasound. MATERIALS AND METHODS From August 2006 to August 2008, 75 pathologically verified pure ductal dilatations without associated masses on breast ultrasound were collected. Ultrasound findings including the diameter and length of the duct, the presence of ductal wall thickening and intraluminal content, the echo pattern of intraluminal content, and distribution were evaluated. The ultrasound findings were correlated with clinical and pathologic features, and radiologic differences between benign and malignant lesions were assessed using Fisher's exact tests. RESULTS Of the 75 cases with abnormal ductal dilatations, seven (9%) were malignant, and four (5%) were atypical ductal hyperplasia. Ductal dilatations were longer in malignancies than in benign lesions (P < .05). Ductal wall thickening was more frequent in malignancies (100%) and atypical ductal hyperplasia (50%) than in other benign lesions (3%) (P < .05). Hypoechoic intraluminal content was more common in malignancies (86%) and atypical ductal hyperplasia (50%) than in other benign lesions (8%) (P < .05). Furthermore, a segmental distribution was more frequent in malignancies (43%) than in benign lesions (1%). Clinical symptoms were also frequent in malignancies (86%) than in benign lesions (4%) (P < .05). CONCLUSIONS Abnormal ductal dilatations without masses have a 9% malignancy rate, and these would be recommended to undergo biopsy as suspicious abnormalities according to Breast Imaging Reporting and Data System - Ultrasound. Ultrasound has an essential role in the assessment of abnormal ducts for distinguishing benign and malignant ductal changes.
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Bae MS, Han W, Koo HR, Cho N, Chang JM, Yi A, Park IA, Noh DY, Choi WS, Moon WK. Characteristics of breast cancers detected by ultrasound screening in women with negative mammograms. Cancer Sci 2011; 102:1862-7. [PMID: 21752153 DOI: 10.1111/j.1349-7006.2011.02034.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Screening ultrasound (US) can increase the detection of breast cancer. However, little is known about the clinicopathologic characteristics of breast cancers detected by screening US. A search of the database for patients with breast cancer yielded a dataset in 6837 women who underwent breast surgery at Seoul National University Hospital (Korea). Of 6837 women, 1047 were asymptomatic and had a non-palpable cancer. Two hundred fifty-four women with 256 cancers detected by US (US-detected cancer) and 793 women with 807 cancers detected by mammography (MG-detected cancer) were identified. The imaging, clinicopathologic, and molecular data were reviewed. Univariate and multivariate analyses were carried out. Women with US-detected cancer were younger and were more likely to undergo breast-conserving surgery and to have node-negative invasive cancer (P < 0.0001). By multivariate analysis, the significant independent characteristics were tumor size, mammographic density, final assessment category according to the American College of Radiology Breast Imaging Reporting and Data System, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and molecular subtype. Compared to tumors that were > 2 cm in size, tumors that were ≤ 1 cm in size were 2.2-fold more likely to be US-detected cancers (P = 0.02). Compared to the luminal A subtype tumors (estrogen receptor [ER]+, PR+, HER2-), luminal B subtype tumors (ER+, PR+, HER2+) were less likely to be in the US-detected cancer group (P < 0.01). Women with dense breasts were more likely to have US-detected cancer (P < 0.01) versus those with non-dense breasts. Screening US-detected cancers were less likely to be diagnosed as category 5 instead of category 4 (P < 0.01). In conclusion, women with US-detected breast cancer are more likely to have small-sized invasive cancer and more likely associated with the luminal A subtype.
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Affiliation(s)
- Min Sun Bae
- Department of Radiology and Clinical Research Institute, Seoul National University Medical Research Center, Seoul National University Hospital and Institute of Radiation Medicine, Seoul, Korea
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Itakura K, Lessing J, Sakata T, Heinzerling A, Vriens E, Wisner D, Alvarado M, Esserman L, Ewing C, Hylton N, Hwang ES. The impact of preoperative magnetic resonance imaging on surgical treatment and outcomes for ductal carcinoma in situ. Clin Breast Cancer 2011; 11:33-8. [PMID: 21421520 DOI: 10.3816/cbc.2011.n.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although magnetic resonance imaging (MRI) is a useful imaging modality for invasive cancer, its role in preoperative surgical planning for ductal carcinoma in situ (DCIS) has not been established. We sought to determine whether preoperative MRI affects surgical treatment and outcomes in women with pure DCIS. PATIENTS AND METHODS We reviewed consecutive records of women diagnosed with pure DCIS on core biopsy between 2000 and 2007. Patient characteristics, surgical planning, and outcomes were compared between patients with and without preoperative MRI. Multivariable regression was performed to determine which covariates were independently associated with mastectomy or sentinel lymph node biopsy (SLNB). RESULTS Of 149 women diagnosed with DCIS, 38 underwent preoperative MRI. On univariate analysis, patients undergoing MRI were younger (50 years vs. 59 years; P < .001) and had larger DCIS size on final pathology (1.6 cm vs. 1.0 cm; P = .007) than those without MRI. Mastectomy and SLNB rates were significantly higher in the preoperative MRI group (45% vs. 14%, P < .001; and 47% vs. 23%, P = .004, respectively). However, there were no differences in number of re-excisions, margin status, and margin size between the two groups. On multivariate analysis, preoperative MRI and age were independently associated with mastectomy (OR, 3.16, P = .018; OR, 0.95, P = .031, respectively), while multifocality, size, and family history were not significant predictors. CONCLUSION We found a strong association between preoperative MRI and mastectomy in women undergoing treatment for DCIS. Additional studies are needed to examine the increased rates of mastectomy as a possible consequence of preoperative MRI for DCIS.
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Affiliation(s)
- Kaoru Itakura
- Department of Surgery, University of California, San Francisco, USA
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Wang X, Xu P, Wang Y, Grant EG. Contrast-enhanced ultrasonographic findings of different histopathologic types of breast cancer. Acta Radiol 2011; 52:248-55. [PMID: 21498359 DOI: 10.1258/ar.2010.100279] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The new application of contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast masses has evolved quickly only in recent years. Nevertheless, mixed results owing to the overlap in characteristics of benign and malignant lesions are simultaneously discovered by most studies, partially attributed to different histopathologic characteristics of breast cancer. PURPOSE To explore the characteristics of different histopathologic types of breast cancer at real-time gray-scale CEUS and evaluate its diagnostic value. MATERIAL AND METHODS One hundred and one histopathologically confirmed malignant lesions were included. We retrospectively reviewed the contrast-enhanced ultrasonographic findings including morphologic features, quantitative parameters, and correlated them with histopathology. True-positive rate was calculated to assess the diagnostic performance of CEUS. RESULTS The 101 malignancies displayed irregular shape (72 [71%]), poorly-defined margin (73 [72%]), penetrating or tortuous surrounding vessels (79 [78%]), heterogeneous enhancement (84 [83%]), including focal perfusion defects (24 [24%]). For each histopathologic type, 87% (58/67) of invasive ductal carcinoma (IDC) showed heterogeneous enhancement. Of all the 24 perfusion defects, IDC account for 88% (21/24). Low average peak intensity (PI) of 4.9 was detected in this type. Ductal carcinoma in situ (DCIS) excellently showed the features of irregular shape (82% [14/17]), poorly-defined margin (82% [14/17]), heterogeneous enhancement (94% [16/17]). While 83% (5/6) of medullary carcinoma exhibited regular shape, well-defined margin, homogenous enhancement, and high average PI value of 9.6. Invasive lobular carcinoma showed similar enhancement pattern to that of IDC. Intraductal papillary carcinoma displayed high average PI value of 8.1. The overall true-positive rate for conventional US and CEUS was 88%, 86%, respectively. DCIS, medullary carcinoma, and intraductal papillary carcinoma achieved an improved true-positive rate (94%, 100% and 100%, respectively). CONCLUSION The imaging characteristics of CEUS are variable in different histopathologic types of breast cancer. CEUS does not appear to be superior to conventional ultrasound as a diagnostic tool overall, however, it is a useful adjunct to conventional ultrasound in diagnosing some special types of breast cancer.
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Affiliation(s)
- Xiaohong Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Xu
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Edward G Grant
- Department of Radiology, University of Southern California, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA
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Tea MKM, Grimm C, Heinz-Peer G, Delancey J, Singer C. The predictive value of suspicious sonographic characteristics in atypical cyst-like breast lesions. Breast 2011; 20:165-9. [DOI: 10.1016/j.breast.2010.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/14/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022] Open
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Moon WK, Shen YW, Huang CS, Chiang LR, Chang RF. Computer-aided diagnosis for the classification of breast masses in automated whole breast ultrasound images. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:539-548. [PMID: 21420580 DOI: 10.1016/j.ultrasmedbio.2011.01.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/23/2010] [Accepted: 01/07/2011] [Indexed: 05/30/2023]
Abstract
New automated whole breast ultrasound (ABUS) machines have recently been developed and the ultrasound (US) volume dataset of the whole breast can be acquired in a standard manner. The purpose of this study was to develop a novel computer-aided diagnosis system for classification of breast masses in ABUS images. One hundred forty-seven cases (76 benign and 71 malignant breast masses) were obtained by a commercially available ABUS system. Because the distance of neighboring slices in ABUS images is fixed and small, these continuous slices were used for reconstruction as three-dimensional (3-D) US images. The 3-D tumor contour was segmented using the level-set segmentation method. Then, the 3-D features, including the texture, shape and ellipsoid fitting were extracted based on the segmented 3-D tumor contour to classify benign and malignant tumors based on the logistic regression model. The Student's t test, Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. From the Az values of ROC curves, the shape features (0.9138) are better than the texture features (0.8603) and the ellipsoid fitting features (0.8496) for classification. The difference was significant between shape and ellipsoid fitting features (p = 0.0382). However, combination of ellipsoid fitting features and shape features can achieve a best performance with accuracy of 85.0% (125/147), sensitivity of 84.5% (60/71), specificity of 85.5% (65/76) and the area under the ROC curve Az of 0.9466. The results showed that ABUS images could be used for computer-aided feature extraction and classification of breast tumors.
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Affiliation(s)
- Woo Kyung Moon
- Department of Diagnostic Radiology, Seoul National University Hospital, Korea
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Pistolese CA, Perretta T, Cossu E, Della Gatta F, Giura S, Simonetti G. Value of the correct diagnostic pathway through conventional imaging (mammography and ultrasound) in evaluating breast disease. Radiol Med 2011; 116:584-94. [PMID: 21431300 DOI: 10.1007/s11547-011-0657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the role of the correct diagnostic pathway through conventional imaging in evaluating breast disease. MATERIALS AND METHODS Six hundred patients aged between 35 and 75 years were enrolled in the study. All patients underwent detailed history and clinical examination, ultrasound (US) and mammography. US scans were repeated after mammography. All suspicious lesions were studied by cytological and histological characterisation and magnetic resonance (MR) imaging. RESULTS The first US scan showed 147 solid lesions, 67 lesions characterised by posterior acoustic shadowing and 193 areas of heterogeneous echostructure. The second US scan, performed after mammography, confirmed 123/147 solid nodular lesions, 53/67 lesions characterised by posterior acoustic shadowing and 183/193 areas of heterogeneous echostructure; it also showed 13 nodular lesions not seen on the first scan and two cases of nodular lesions with irregular calcifications. CONCLUSIONS Our experience suggests that US not performed in conjunction with mammography gives rise to incorrect diagnostic interpretations (either false positive or false negative results). The detection rate of the US scan performed after mammography increases from 4.16% to 5.5%.
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Affiliation(s)
- C A Pistolese
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Terapia Radiante, Università degli studi di Roma Tor Vergata (PTV), Viale Oxford 81, 00133, Roma, Italy.
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