Role of MRI in differentiating benign from malignant breast lesions using dynamic contrast enhanced MRI and diffusion weighted MRI

Accuracy of multiparametric MRI in distinguishing the breast malignant lesions from benign lesions: a meta-analysis

BACKGROUND

The sensitivity of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for detecting breast cancer was high and the specificity was relatively low. However, diffusion-weighted imaging (DWI) has a high specificity in the diagnosis of malignant lesions.

PURPOSE

To evaluate the accuracy of the multiparametric MRI (mp-MRI) in distinguishing the breast malignant lesions from the benign lesions.

MATERIAL AND METHODS

A comprehensive search of the PubMed, Embase, and Cochrane Library electronic databases was conducted up to March 2020. Data were analyzed for the following indexes: pooled sensitivity and specificity; positive likelihood ratio; negative likelihood ratio; diagnostic odds ratio; and the area under the curve.

RESULTS

A total of 2356 patients with 1604 malignant and 967 benign breast lesions were included from 22 studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve for mp-MRI were 0.93, 0.85, 6.3, 0.08, 81, and 0.96, respectively. The pooled sensitivity, specificity, and area under the curve for DCE-MRI alone were 0.95, 0.71, and 0.92, respectively. The pooled sensitivity, specificity, and area under the curve for DWI alone were 0.88, 0.84, and 0.93, respectively.

CONCLUSION

The mp-MRI did not improve the sensitivity but increased the specificity for the diagnosis of breast malignant lesions.

Staging MRI of uterine malignant mixed Müllerian tumors versus endometrial carcinomas with emphasis on dynamic enhancement characteristics

PURPOSE

To determine whether staging pelvic magnetic resonance imaging (MRI) can distinguish malignant mixed Müllerian tumor (MMMT) from EC.

METHODS

Thirty-seven treatment-naïve patients with histologically proven uterine MMMT and 42 treatment-naïve patients with EC, treated at our institution, were included in our retrospective study. Staging pelvic MRI scans were reviewed for tumor size, prolapse through cervical os, and other features. Time-intensity curves for tumor and surrounding myometrium regions of interest were generated, and positive enhancement integral (PEI), maximum slope of increase (MSI), and signal enhancement ratio (SER) were measured. The Fisher's exact test or Wilcoxon rank-sum test was used to compare characteristics between disease groups. Multivariate and univariate logistic regression models were used to distinguish MMMT from EC. Receiver operating characteristic analysis and the area under the curve (AUC) were used to evaluate prediction ability.

RESULTS

MMMTs were larger than ECs with higher rate of tumor prolapse and more heterogeneous tumor enhancement compared to ECs. During the late phase of contrast enhancement, 100% of ECs, but only 84% of MMMTs, had lower signal intensity than the myometrium. Threshold PEI ratio ≥ 0.67 predict MMMT with 76% sensitivity, 84%, specificity and 0.83 AUC. Threshold SER ≤ 125 predict MMMT with 90% sensitivity, 50% specificity, and 0.72 AUC.

CONCLUSION

MMMTs may show more frequent tumor prolapse, more heterogeneous enhancement, delayed iso- or hyper-enhancement, higher PEI ratios, and lower tumor SERs compared with EC. MRI can be used as a biomarker to distinguish MMMT from EC based on the enhancement pattern.

Breast Self-Examination: Knowledge and Practice Among Female Textile Workers in Vietnam

Breast self-examination (BSE) is a simple, feasible, and suitable method for breast cancer screening in low–middle setting countries. The aim of this study was to assess the knowledge and practice of BSE among female textile workers in Vietnam. A cross-sectional study was conducted among 1036 female workers, aged 43.9 ± 3.1 years old, who were working in 4 textile enterprises in Hanoi and Ho Chi Minh City, in 2016. Overall, 22.7% of participants showed sufficient knowledge on BSE; 15.2% performed monthly BSE; and 7.7% completely performed all 5 steps of BSE. The prevalence of insufficient BSE knowledge was higher among participants with low level of education (odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.22-2.39, below vs above secondary school), and those whose husbands were farmers or workers (OR: 1.76; 95% CI: 1.27-2.45, compared to other sectors). This prevalence was, however, negatively associated with receiving information on BSE (OR: 0.16; 95% CI: 0.11-0.23, yes vs no). The prevalence of insufficient BSE practice was also higher among females with husbands who were farmers or workers (OR: 1.67; 95% CI: 1.15-2.43, compared to other sectors). In contrast, it was much lower among participants who had history of breast-related diseases (OR: 0.46; 95% CI: 0.24-0.88, yes vs no), received BSE information (OR: 0.13; 95% CI: 0.08-0.19, yes vs no), and had sufficient overall BSE knowledge (OR: 0.09; 95% CI: 0.06-0.13, yes vs no), compared to those who did not. There was a low prevalence of sufficient BSE knowledge (22.7%) and practice (15.8%) among female textile workers in Hanoi and Ho Chi Minh City. Low level of education and not being provided BSE information were associated with insufficient BSE knowledge and practice among Vietnamese female textile workers. Health education programs are essential to encourage and improve women’s knowledge and practice of BSE.