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Porkodi D, Devimeenal J. Role of contrast-enhanced mammogram as an adjunct to tomosynthesis in evaluation of circumscribed breast lesions. Br J Radiol 2024; 97:1696-1705. [PMID: 39024041 PMCID: PMC11417351 DOI: 10.1093/bjr/tqae130] [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: 11/20/2023] [Revised: 03/01/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES We evaluated the role of contrast-enhanced mammogram (CEM) in the characterization of circumscribed lesions detected in digital breast tomosynthesis (DBT) and correlated with histopathology. METHODS A retrospective study was done on 205 circumscribed breast masses detected with DBT and for whom CEM was done before core biopsy/excision biopsy. Morphology of lesion enhancement was noted at a 2-min CEM image and depending on the enhancement pattern, they were classified as benign, malignant, and indeterminate. Indeterminate lesions were further characterized by contrast kinetics at 8 min and divided into benign and malignant lesions. The results were correlated with histopathology reports. RESULTS Among the 205 lesions, 158 were benign and 47 were malignant by histopathology. All 47 malignant cases were diagnosed as malignant (sensitivity-100%) and 150 out of 158 benign lesions were diagnosed as benign by CEM (specificity-95%). Eight benign lesions were reported as malignant (false positive) by CEM. Positive predictive value was 85.4% (47/55); negative predictive value (NPV) was 100% (150/150); accuracy was 96% (197/205). CONCLUSIONS The high sensitivity of CEM in our study suggests that CEM helps in the early diagnosis of benign-looking circumscribed breast malignancies. The high NPV of CEM helps to avoid unnecessary biopsies and interventions in benign lesions. ADVANCES IN KNOWLEDGE This study describes the contrast enhancement pattern of benign and malignant circumscribed breast lesions and thereby helps in the diagnosis of malignancy at an early stage. CEM is a promising adjunct tool since it offers functional imaging as a supplement to anatomical imaging by DBT.
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Affiliation(s)
- Dharmalingam Porkodi
- Institute of Radiodiagnosis, Government Kilpauk Medical College and Hospital, Chennai 600010, Tamil Nadu, India
| | - Jagannathan Devimeenal
- Institute of Radiodiagnosis, Government Kilpauk Medical College and Hospital, Chennai 600010, Tamil Nadu, India
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Bellini C, Pugliese F, Bicchierai G, Amato F, De Benedetto D, Di Naro F, Boeri C, Vanzi E, Migliaro G, Incardona L, Tommasi C, Orzalesi L, Miele V, Nori J. Contrast-enhanced mammography in the management of breast architectural distortions and avoidance of unnecessary biopsies. Breast Cancer 2024; 31:851-857. [PMID: 38811515 DOI: 10.1007/s12282-024-01599-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: 03/10/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND To assess contrast-enhanced mammography (CEM) in the management of BI-RADS3 breast architectural distortions (AD) in digital breast tomosynthesis (DBT). METHODS We retrospectively reviewed 328 women with 332 ADs detected on DBT between 2017 and 2021 and selected those classified as BI-RADS3 receiving CEM as problem-solving. In CEM recombined images, we evaluated AD's contrast enhancement (CE) according to its presence/absence, type, and size. AD with enhancement underwent imaging-guided biopsy while AD without enhancement follow-up or biopsy if detected in high/intermediate-risk women. RESULTS AD with enhancement were 174 (52.4%): 72 (41.4%) were malignant lesions, 102 (59.6%) false positive results: 28 (16%) B3 lesions, and 74 (42.5%) benign lesions. AD without enhancement were 158 (47.6%): 26 (16.5%) were subjected to biopsy (1 malignant and 25 benign) while the other 132 cases were sent to imaging follow-up, still negative after two years. CEM's sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy were 98.63%, 60.62%, 41.38%, 99.37%, and 68.98%. The AUC determined by ROC was 0.796 (95% CI, 0.749-0.844). CONCLUSION CEM has high sensitivity and NPV in evaluating BI-RADS3 AD and can be a complementary tool in assessing AD, avoiding unnecessary biopsies without compromising cancer detection.
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Affiliation(s)
- Chiara Bellini
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesca Pugliese
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Bicchierai
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Amato
- Department of Radiology, Breast Imaging Unit, "Ospedale San Giovanni di Dio", Agrigento, Italy
| | - Diego De Benedetto
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuliano Migliaro
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ludovica Incardona
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cinzia Tommasi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Helal M, Khaled R, Alfarghaly O, Mokhtar O, Elkorany A, Fahmy A, El Kassas H. Validation of artificial intelligence contrast mammography in diagnosis of breast cancer: Relationship to histopathological results. Eur J Radiol 2024; 173:111392. [PMID: 38428255 DOI: 10.1016/j.ejrad.2024.111392] [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: 06/14/2023] [Revised: 01/12/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Contrast-enhanced mammography (CEM) is used for characterization of breast lesions with increased diagnostic accuracy compared to digital mammography (DM). Artificial intelligence (AI) approaches are emerging with accuracies equal to an average radiologist. However, most studies trained deep learning (DL) models on DM images and there is a paucity in literature for discovering the application of AI using CEM. OBJECTIVES To develop and test a DL model that classifies CEM images and produces corresponding highlights of lesions detected. METHODS Fully annotated 2006 images of 326 females available from the previously published Categorized Digital Database for Contrast Enhanced Mammography images (CDD-CESM) were used for training. We developed a DL multiview contrast mammography model (MVCM) for classification of CEM low energy and recombined images. An external test set of 288 images of 37 females not included in the training was used for validation. Correlation with histopathological results and follow-up was considered the standard reference. The study protocol was approved by the Institutional Review Board and patient informed consent was obtained. RESULTS Assessment was done on an external test set of 37 females (mean age, 51.31 years ± 11.07 [SD]) with AUC-ROC for AI performance 0.936; (95 % CI: 0.898, 0.973; p < 0.001) and the best cut off value for prediction of malignancy using AI score = 0.28. Findings were then correlated with histopathological results and follow up which revealed a sensitivity of 75 %, specificity 96.3 %, total accuracy of 90.1 %, positive predictive value (PPV) 87.1 %, and negative predictive value (NPV) 92 %, p-value (<0.001). Diagnostic indices of radiologists were sensitivity 88.9 %, specificity 92.6 %, total accuracy 91.7 %, PPV 80 %, and NPV 96.2 %, p-value (<0.001). CONCLUSION A deep learning multiview CEM model was developed and evaluated in a cohort of female participants and showed promising results in detecting breast cancer. This warrants further studies, external training, and validation.
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Affiliation(s)
- Maha Helal
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Rana Khaled
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Omar Alfarghaly
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Omnia Mokhtar
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Abeer Elkorany
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Aly Fahmy
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Hebatalla El Kassas
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
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Wong CYY, Lee SYS, Mahmood RD. Contrast-enhanced spectral mammography. Singapore Med J 2024; 65:195-201. [PMID: 38527307 PMCID: PMC11060636 DOI: 10.4103/singaporemedj.smj-2021-268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/18/2022] [Indexed: 03/27/2024]
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Goh Y, Quek ST, Pillay P, Chou CP. Evaluation of architectural distortion with contrast-enhanced mammography. Clin Radiol 2024; 79:163-169. [PMID: 38114374 DOI: 10.1016/j.crad.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Architectural distortion (AD) is the third most common abnormality detected on mammograms. In the absence of an accurate non-invasive tool to evaluate ADs, clinical management often requires surgical excision for histological diagnosis. This problem is expected to worsen with the growing use of digital breast tomosynthesis (DBT) and the resultant increasing detection of ADs. There is therefore a great clinical need for a diagnostic imaging tool to complement non-enhanced mammography for the evaluation of AD. Contrast-enhanced mammography (CEM) is an emerging breast imaging method that uses contrast media and the principle of dual-energy subtraction to evaluate vascularity of suspicious breast lesions. CEM, a cost-effective alternative to breast magnetic resonance imaging (MRI), can be used to evaluate AD by juxtaposing CEM images with non-enhanced mammograms for comparison. In this review, the authors aim to provide readers with an overview of the interpretation of AD on CEM using imaging examples. Relevant imaging features of CEM and their respective significance will be matched with information from a literature review. Finally, the authors would like to highlight the added value of CEM in relevant clinical applications in the assessment of AD.
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Affiliation(s)
- Y Goh
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - S T Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - P Pillay
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - C-P Chou
- Kaohsiung Veterans General Hospital, Radiology Department, No. 386, Dazhong 1st Rd, Zuoying Dist., Kaohsiung City 81362, Taiwan, ROC.
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Rubio IT, Wyld L, Marotti L, Athanasiou A, Regitnig P, Catanuto G, Schoones JW, Zambon M, Camps J, Santini D, Dietz J, Sardanelli F, Varga Z, Smidt M, Sharma N, Shaaban AM, Gilbert F. European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107292. [PMID: 38061151 DOI: 10.1016/j.ejso.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Breast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. METHODS These guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. RESULTS Recommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. CONCLUSIONS These guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.
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Affiliation(s)
- Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain; European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy; European Society of Surgical Oncology (ESSO), Brussels, Belgium.
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | | | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Giuseppe Catanuto
- Humanitas-Istituto Clinico Catanese Misterbianco, Italy; Fondazione G.Re.T.A., ETS, Napoli, Italy
| | - Jan W Schoones
- Research Policy & Graduate School Advisor, Leiden University Medical Center Leiden, the Netherlands
| | - Marzia Zambon
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Julia Camps
- Breast Health Units in Ribera Salud Hospitals.Valencia, Spain
| | - Donatella Santini
- Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Jill Dietz
- The American Society of Breast Surgeons, Columbia, MD, USA
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Marjolein Smidt
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street Leeds, West Yorkshire, LS9 7TF, UK
| | - Abeer M Shaaban
- Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, UK.
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Brown AL, Vijapura C, Patel M, De La Cruz A, Wahab R. Breast Cancer in Dense Breasts: Detection Challenges and Supplemental Screening Opportunities. Radiographics 2023; 43:e230024. [PMID: 37792590 DOI: 10.1148/rg.230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Dense breast tissue at mammography is associated with higher breast cancer incidence and mortality rates, which have prompted new considerations for breast cancer screening in women with dense breasts. The authors review the definition and classification of breast density, density assessment methods, breast cancer risk, current legislation, and future efforts and summarize trials and key studies that have affected the existing guidelines for supplemental screening. Cases of breast cancer in dense breasts are presented, highlighting a variety of modalities and specific imaging findings that can aid in cancer detection and staging. Understanding the current state of breast cancer screening in patients with dense breasts and its challenges is important to shape future considerations for care. Shifting the paradigm of breast cancer detection toward early diagnosis for women with dense breasts may be the answer to reducing the number of deaths from this common disease. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Yeh in this issue.
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Affiliation(s)
- Ann L Brown
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Charmi Vijapura
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Mitva Patel
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Alexis De La Cruz
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Rifat Wahab
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
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Manzar BZ, Phillips J, Dibble EH, Quintana LM, Lourenco AP. Imaging and Management of Radial Scars and Complex Sclerosing Lesions. Radiographics 2023; 43:e230022. [PMID: 37733620 DOI: 10.1148/rg.230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Radial scars and complex sclerosing lesions, often collectively referred to as radial sclerosing lesions (RSLs), are breast lesions characterized by sclerotic stroma with entrapped epithelial elements. RSLs have imaging features that overlap with those of breast malignancy and often become the target of imaging-guided biopsy given their suspicious imaging appearance. These can be identified in isolation or can also be associated with atypia or other high-risk lesions that have intrinsic malignant potential, increasing the risk of carcinoma and affecting prognosis and management of RSLs. Because of this, management of these lesions remains controversial. Traditional management has been surgical excisional biopsy. However, as more RSLs are identified (because digital breast tomosynthesis allows identification of more architectural distortions), optimal management is evolving. Physicians in some practices are using a multidisciplinary approach to the management of RSLs when deciding on surgical excision of these lesions versus imaging follow-up. These discussions also incorporate individual patient risk factors and greater patient informed medical decision making. Reported upgrade rates of RSLs at core needle biopsy vary and can depend on the sampling method, number of samples, gauge of the needle, target being sampled, and radiologic-pathologic concordance or discordance. A precise sampling technique also allows greater accuracy of diagnosis and lower upgrade rates for these lesions, with radiologic-pathologic correlation as an integral component for further management decisions. The authors review the overall histopathologic, clinical, and imaging features of RSLs and discuss appropriate management based on currently available data regarding upgrade rates. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Bushra Z Manzar
- From the Department of Radiology, Boston Medical Center, Boston, Mass (B.Z.M., J.P.); Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, 3rd Floor, Providence, RI 02903 (E.H.D., A.P.L.); and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (L.M.Q.)
| | - Jordana Phillips
- From the Department of Radiology, Boston Medical Center, Boston, Mass (B.Z.M., J.P.); Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, 3rd Floor, Providence, RI 02903 (E.H.D., A.P.L.); and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (L.M.Q.)
| | - Elizabeth H Dibble
- From the Department of Radiology, Boston Medical Center, Boston, Mass (B.Z.M., J.P.); Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, 3rd Floor, Providence, RI 02903 (E.H.D., A.P.L.); and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (L.M.Q.)
| | - Liza M Quintana
- From the Department of Radiology, Boston Medical Center, Boston, Mass (B.Z.M., J.P.); Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, 3rd Floor, Providence, RI 02903 (E.H.D., A.P.L.); and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (L.M.Q.)
| | - Ana P Lourenco
- From the Department of Radiology, Boston Medical Center, Boston, Mass (B.Z.M., J.P.); Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy St, 3rd Floor, Providence, RI 02903 (E.H.D., A.P.L.); and Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (L.M.Q.)
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Bennett C, Woodard S, Zamora K. A pictorial guide to artifacts on contrast mammography: How to avoid pitfalls and improve interpretation. Clin Imaging 2023; 101:215-222. [PMID: 37429167 DOI: 10.1016/j.clinimag.2023.06.019] [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: 05/05/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
Contrast-enhanced mammography (CEM) is an increasingly accepted emerging imaging modality that demonstrates a similar sensitivity to MRI but has the advantage of being less time consuming and inexpensive. The use of CEM continues to expand as it is recognized and utilized as a valuable tool for diagnostic and potentially screening examinations. As with any radiologic examination, artifacts occur and knowledge of these is important for adequate image interpretation. The purpose of this paper is to provide a pictorial review the common artifacts encountered on CEM examinations and identify causes and potential resolutions.
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Affiliation(s)
- Caroline Bennett
- Heersink School of Medicine, University of Alabama Birmingham, 510 20th St S, Birmingham, AL 35233, United States
| | - Stefanie Woodard
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States
| | - Kathryn Zamora
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States.
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Speer ME, Yoon EC, Berg WA, Chang Sen LQ. Pseudoangiomatous Stromal Hyperplasia: Radiologic-Pathologic Correlation. JOURNAL OF BREAST IMAGING 2023; 5:67-72. [PMID: 36778653 PMCID: PMC9901424 DOI: 10.1093/jbi/wbac051] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Indexed: 11/12/2022]
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. PASH is postulated to be hormonally induced and predominantly occurs in premenopausal women and postmenopausal women on menopausal hormone therapy. Clinical presentation varies from screen-detected lesions to palpable masses. Imaging findings of PASH are nonspecific. The most common mammographic findings are an oval or round circumscribed non-calcified mass or developing asymmetry. On US, PASH is often seen as an oval hypoechoic mass that may be circumscribed and can have an echogenic rim, or, when manifest as mammographic asymmetry, US may show a corresponding non-mass focal area of echogenic tissue. Limited studies have investigated the MRI appearance, with PASH most often manifesting as non-mass enhancement, or, less often, as an oval or irregular mass with persistent kinetics. Histopathologically, PASH can be mistaken for a fibroadenoma or phyllodes tumor and has features overlapping low-grade angiosarcoma. Assessment of radiologic-pathologic concordance is particularly important as PASH is often an incidental finding, adjacent to the targeted lesion at histopathology. Surgical excision or repeat core-needle biopsy is necessary for discordant suspicious cases. After a benign, concordant diagnosis of PASH, the patient may resume routine screening.
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Affiliation(s)
- Megan E Speer
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Esther C Yoon
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Wendie A Berg
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA, USA
| | - Lauren Q Chang Sen
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
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Liu Y, Tong Y, Wan Y, Xia Z, Yao G, Shang X, Huang Y, Chen L, Chen DQ, Liu B. Identification and diagnosis of mammographic malignant architectural distortion using a deep learning based mask regional convolutional neural network. Front Oncol 2023; 13:1119743. [PMID: 37035200 PMCID: PMC10075355 DOI: 10.3389/fonc.2023.1119743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background Architectural distortion (AD) is a common imaging manifestation of breast cancer, but is also seen in benign lesions. This study aimed to construct deep learning models using mask regional convolutional neural network (Mask-RCNN) for AD identification in full-field digital mammography (FFDM) and evaluate the performance of models for malignant AD diagnosis. Methods This retrospective diagnostic study was conducted at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2011 and December 2020. Patients with AD in the breast in FFDM were included. Machine learning models for AD identification were developed using the Mask RCNN method. Receiver operating characteristics (ROC) curves, their areas under the curve (AUCs), and recall/sensitivity were used to evaluate the models. Models with the highest AUCs were selected for malignant AD diagnosis. Results A total of 349 AD patients (190 with malignant AD) were enrolled. EfficientNetV2, EfficientNetV1, ResNext, and ResNet were developed for AD identification, with AUCs of 0.89, 0.87, 0.81 and 0.79. The AUC of EfficientNetV2 was significantly higher than EfficientNetV1 (0.89 vs. 0.78, P=0.001) for malignant AD diagnosis, and the recall/sensitivity of the EfficientNetV2 model was 0.93. Conclusion The Mask-RCNN-based EfficientNetV2 model has a good diagnostic value for malignant AD.
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Affiliation(s)
- Yuanyuan Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunfei Tong
- Department of Engineering, Shanghai Yanghe Huajian Artificial Intelligence Technology Co., Ltd, Shanghai, China
| | - Yun Wan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziqiang Xia
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyan Yao
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojing Shang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Huang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lijun Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daniel Q. Chen
- Artificial Intelligence (AI), Research Lab, Boston Meditech Group, Burlington, MA, United States
- *Correspondence: Bo Liu, ; Daniel Q. Chen,
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Bo Liu, ; Daniel Q. Chen,
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12
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Myers KS, Oluyemi ET, Mullen LA, Panigrahi B, Di Carlo PA, Nguyen DL, Ambinder EB. Outcomes of Canceled Tomosynthesis-Guided Biopsy of Architectural Distortion Due to Nonvisualization. JOURNAL OF BREAST IMAGING 2022; 4:400-407. [PMID: 35915845 PMCID: PMC9334780 DOI: 10.1093/jbi/wbac038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 10/12/2024]
Abstract
OBJECTIVE Architectural distortion without a sonographic correlate is an indication for digital breast tomosynthesis-guided vacuum-assisted biopsy (DBT-VAB). However, when the finding is not visualized on the day of biopsy, the procedure is canceled. This study reports the outcomes of canceled DBT-VAB of architectural distortion due to nonvisualization. METHODS In this IRB-approved retrospective study, chart review was performed to identify DBT-VABs of architectural distortion at our institution between June 1, 2017, and November 1, 2020, that were canceled because of nonvisualization at the time of biopsy. Cases without follow-up imaging were excluded. Statistical analysis, including the frequency of cases yielding malignancy by the end of the study period, was performed. RESULTS In total, 7.2% (39/544) of architectural distortions recommended for biopsy during the study period were canceled because of nonvisualization, 30 of which had follow-up imaging and were included in the study. Mean patient age was 56 years (standard deviation [SD], 9.6 years) and mean follow-up time was 26.7 months (SD, 11.2 months; range, 8.4-50.9 months). During the follow-up period, 16.7% (5/30) underwent repeat biopsy attempt, with one malignant result (1/30, 3.3%; SD, 18%; 95% confidence interval: 0.6%-16.7%). In total, 86.7% (26/30) of cases were declared benign during the follow-up period and 10% (3/30) remained stable with a BI-RADS 3 assessment category. CONCLUSION During available follow-up, there was a low likelihood that distortions not visualized at the time of DBT-VAB represented malignancy (3.3%, 1/30). While this low malignancy rate is reassuring, imaging follow-up is warranted.
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Affiliation(s)
- Kelly S Myers
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Eniola T Oluyemi
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Lisa A Mullen
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Babita Panigrahi
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Philip A Di Carlo
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Derek L Nguyen
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Emily B Ambinder
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
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13
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Amir T, Hogan MP, Jacobs S, Sevilimedu V, Sung J, Jochelson MS. Comparison of False-Positive Versus True-Positive Findings on Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol 2022; 218:797-808. [PMID: 34817195 PMCID: PMC9110098 DOI: 10.2214/ajr.21.26847] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. Contrast-enhanced digital mammography (CEDM) has been shown to outperform standard mammography while performing comparably to contrast-enhanced MRI. OBJECTIVE. The purpose of our study was to compare imaging characteristics of false-positive and true-positive findings on CEDM. METHODS. This retrospective study included women who underwent baseline screening CEDM between January 2013 and December 2018 assessed as BI-RADS category 0, 3, 4, or 5 and who underwent biopsy with histopathologic diagnosis or had a 2-year imaging follow-up. Lesion characteristics were extracted from CEDM reports. A true-positive finding was defined as a lesion in which biopsy yielded malignancy. A false-positive finding was defined as a lesion in which biopsy yielded benign or benign high-risk pathology or in which 2-year imaging follow-up was negative. RESULTS. Of 157 patients (median age, 52 years), 24 had a total of 26 true-positive lesions, and 133 had a total of 147 false-positive lesions. Of the 26 true-positive lesions, one (4%) exhibited only a mammographic finding on low-iodine images, 13 (50%) exhibited only a contrast finding on iodine images, and 12 (46%) exhibited both a mammographic finding on low-energy images and a contrast finding on iodine images. A true-positive result was more likely (p = .02) for lesions present on both low-energy images and iodine images (31%) than on low-energy images only (4%) or iodine images only (12%). Among lesions present on both low-energy and iodine images, a true-positive result was more likely (p < .001) when the type of mammographic finding was an asymmetry (46%) or calcification (80%) than a mass (11%) or distortion (0%). A true-positive result was more likely (p = .01) among those with, versus those without, an ultrasound correlate (36% vs 9%) and also was more likely (p = .02) among those with, versus those without, an MRI correlate (18% vs 2%). Of 25 false-positive calcifications, 24 had no associated mammographic enhancement; of five true-positive calcifications, four had mammographic enhancement. CONCLUSION. A low-energy mammographic finding with associated enhancement or a finding with a sonographic or MRI correlate predicts a true-positive result. Calcifications with associated enhancement had a high malignancy rate. Nonetheless, half of true-positive lesions enhanced on iodine images without a mammographic finding on low-energy images. CLINICAL IMPACT. These observations inform radiologists' management of abnormalities detected on screening CEDM.
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Affiliation(s)
- Tali Amir
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Stefanie Jacobs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Janice Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
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14
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Peters G, Lynch AM, Peters J. Enhancement Patterns in Contrast Mammography - A Pictorial Essay. J Clin Imaging Sci 2021; 11:63. [PMID: 34877070 PMCID: PMC8645489 DOI: 10.25259/jcis_174_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a new technology in breast imaging and cancer detection. It has been shown to have a comparable performance to breast MRI. Currently, there is no independent BI-RADS lexicon available for CEM. This pictorial essay will demonstrate the use of breast MRI descriptors according to the BI-RADS breast MRI lexicon, to describe enhancement patterns for recombined CEM images. The authors recommend using enhancement pattern descriptors already in use for breast MRI when reporting CEM studies, to promote uniformity of interpretation and reporting.
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Affiliation(s)
- Gesine Peters
- Department of Surgery, School of Medicine, University of Tasmania, Hobart, Australia
| | | | - Johannes Peters
- Department of Radiology, Royal Darwin Hospital, Darwin, Australia
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15
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Pathological outcome of sonographically occult architectural distortions (AD) visible only on digital breast tomosynthesis, and comparison with AD visible also on 2D mammography. Eur J Radiol 2021; 146:110075. [PMID: 34864616 DOI: 10.1016/j.ejrad.2021.110075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the rates of malignant and of high-risk lesions among sonographically occult architectural distortions (AD) visible only on digital breast tomosynthesis (DBT) and compare them with AD visible on 2D mammography (2D) and DBT. METHOD The records of 1104 DBT-vacuum assisted biopsies (DBT-VAB) were retrospectively reviewed and 218 cases of AD were identified. Complete radiologic examinations and pathologic results were available for 113 sonographically occult AD (1 clinically-detected, 112 clinically-occult). 2D and DBT images were reviewed and AD were divided into a "DBT-detected" group (visible on only DBT) and a "2D-detected" group (visible both in 2D and DBT). The rates of malignant and of high-risk lesions in the "DBT-detected" AD group were calculated and compared to those of the "2D-detected" AD group. RESULTS Thirty-five (31%) of 113 AD were assessed as "DBT-detected", while 78 (69%) as "2D-detected". DBT-VAB results were benign lesions in 63 (56%) AD, high-risk lesions in 32 (28%) AD and malignant lesions in 18 (16%) AD. Four (12.5%) high-risk lesions were upgraded to malignancy at surgery. Based on final pathology, the malignancy rate was significantly higher in the "DBT-detected" group than the "2D-detected" group (34% [12/35 cases] vs 13% [10/78]; p < 0.05). The high-risk lesion rates were 32% (11/35 cases) in the "DBT-detected" group and 22% (17/78 cases) in the "2D-detected" group (p > 0.05). CONCLUSIONS AD visible on only DBT proved to be malignant in about one third of cases, which exceeded the malignancy rate of AD visible on also 2D. A similar proportion of DBT-only AD was represented by high-risk lesions.
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16
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Woodard S, Murray A. Contrast-Enhanced Mammography: Reviewing the Past and Looking to the Future. Semin Roentgenol 2021; 57:126-133. [DOI: 10.1053/j.ro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
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17
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The diagnostic value of contrast-enhanced 2D mammography in everyday clinical use. Sci Rep 2021; 11:22224. [PMID: 34782698 PMCID: PMC8593172 DOI: 10.1038/s41598-021-01622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022] Open
Abstract
Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.
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18
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Hannsun G, Saponaro S, Sylvan P, Elmi A. Contrast-Enhanced Mammography: Technique, Indications, and Review of Current Literature. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
To provide an update on contrast-enhanced mammography (CEM) regarding current technique and interpretation, the performance of this modality versus conventional breast imaging modalities (mammography, ultrasound, and MRI), existing clinical applications, potential challenges, and pitfalls.
Recent Findings
Multiple studies have shown that the low-energy, non-contrast-enhanced images obtained when performing CEM are non-inferior to full-field digital mammography with the added benefit of recombined post-contrast images, which have been shown to provide comparable information compared to MRI without sacrificing sensitivity and negative predictive values. While CEMs' usefulness for further diagnostic characterization of indeterminate breast findings is apparent, additional studies have provided strong evidence of potential roles in screening intermediate to high-risk populations, evaluation of disease extent, and monitoring response to therapy, particularly in patients in whom MRI is either unavailable or contraindicated. Others have shown that some patients prefer CEM over MRI given the ease of performance and patient comfort. Additionally, some health systems may find significantly reduced costs compared to MRI. Currently, CEM is hindered by the limited availability of CEM-guided tissue sampling and issues of intravenous contrast administration. However, commercially available CEM-guided biopsy systems are on the horizon, and small changes in practice workflow can be quickly adopted. As of now, MRI remains a mainstay of high-risk screening, evaluation of the extent of disease, and monitoring response to therapy, but smaller studies have suggested that CEM may be equivalent to MRI for these indications, and larger confirmatory studies are needed.
Summary
CEM is an emerging problem-solving breast imaging modality that provides complementary information to conventional imaging modalities and may potentially be used in place of MRI for specific indications and/or patient populations.
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19
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Kornecki A. Current Status of Contrast Enhanced Mammography: A Comprehensive Review. Can Assoc Radiol J 2021; 73:141-156. [PMID: 34492211 DOI: 10.1177/08465371211029047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this article is to provide a detailed and updated review of the physics, techniques, indications, limitations, reporting, implementation and management of contrast enhanced mammography. BACKGROUND Contrast enhanced mammography (CEM), is an emerging iodine-based modified dual energy mammography technique. In addition to having the same advantages as standard full-field digital mammography (FFDM), CEM provides information regarding tumor enhancement, relying on tumor angiogenesis, similar to dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). This article reviews current literature on CEM and highlights considerations that are critical to the successful use of this modality. CONCLUSION Multiple studies point to the advantage of using CEM in the diagnostic setting of breast imaging, which approaches that of DCE-MRI.
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Affiliation(s)
- Anat Kornecki
- Department of Medical Imaging, Breast Division, Western University, St. Joseph Health Care, London, Ontario, Canada
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20
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Kim G, Patel B, Mehta TS, Du L, Mehta RJ, Phillips J. Contrast-enhanced Mammography: A Guide to Setting Up a New Clinical Program. JOURNAL OF BREAST IMAGING 2021; 3:369-376. [PMID: 38424777 DOI: 10.1093/jbi/wbab027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 03/02/2024]
Abstract
Contrast-enhanced mammography (CEM) is gaining rapid traction following the U.S. Food and Drug Administration approval for diagnostic indications. Contrast-enhanced mammography is an alternative form of mammography that uses a dual-energy technique for image acquisition after the intravenous administration of iodinated contrast material. The resulting exam includes a dual set of images, one that appears similar to a routine 2D mammogram and one that highlights areas of contrast uptake. Studies have shown improved sensitivity compared to mammography and similar performance to contrast-enhanced breast MRI. As radiology groups incorporate CEM into clinical practice they must first select the indications for which CEM will be used. Many practices initially use CEM as an MRI alternative or in cases recommended for biopsy. Practices should then define the CEM clinical workflow and patient selection to include ordering, scheduling, contrast safety screening, and managing imaging on the day of the exam. The main equipment requirements for performing CEM include CEM-capable mammography equipment, a power injector for contrast administration, and imaging-viewing capability. The main staffing requirements include personnel to place the intravenous line, perform the CEM exam, and interpret the CEM. To safely and appropriately perform CEM, staff must be trained in their respective roles and to manage potential contrast-related events. Lastly, informing referring colleagues and patients of CEM through marketing campaigns is helpful for successful implementation.
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Affiliation(s)
- Geunwon Kim
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Bhavika Patel
- Mayo Clinic Hospital, Department of Radiology, Phoenix, AZ, USA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Linda Du
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Rashmi J Mehta
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Jordana Phillips
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
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21
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Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clin Imaging 2021; 69:269-279. [PMID: 33032103 PMCID: PMC8494428 DOI: 10.1016/j.clinimag.2020.09.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced mammography (CEM) combines conventional mammography with iodinated contrast material to improve cancer detection. CEM has comparable performance to breast MRI without the added cost or time of conventional MRI protocols. Thus, this technique may be useful for indications previously reserved for MRI, such as problem-solving, determining disease extent in patients with newly diagnosed cancer, monitoring response to neoadjuvant therapy, evaluating the posttreatment breast for residual or recurrent disease, and potentially screening in women at intermediate- or high-risk for breast cancer. This article will provide a comprehensive overview on the past, present, and future of CEM, including its evolving role in the diagnostic and screening settings.
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Affiliation(s)
- Julie Sogani
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Victoria L Mango
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
| | - Delia Keating
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Janice S Sung
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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22
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Zamora K, Allen E, Hermecz B. Contrast mammography in clinical practice: Current uses and potential diagnostic dilemmas. Clin Imaging 2020; 71:126-135. [PMID: 33197726 DOI: 10.1016/j.clinimag.2020.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This article will discuss the indications for Contrast Enhanced Spectral Mammography (CESM) with a focus on imaging interpretation including diagnostic dilemmas and pitfalls which may be encountered in practice. CONCLUSION Understanding potential diagnostic dilemmas and pitfalls of CESM allows for enhanced interpretation. The clinical utilization of Contrast Enhanced Spectral Mammography (CESM) has increased significantly over the last few years. CESM demonstrates comparable sensitivity and accuracy to magnetic resonance imaging (MRI) for the evaluation of breast cancer but is less time consuming and less expensive. Because of this, CESM is now being used in lieu of MRI for many diagnostic indicators including the evaluation of abnormal mammographic findings, extent of disease, and response to neoadjuvant therapy. Additionally, ongoing research into the role of CESM in asymptomatic screening for breast cancer is evolving. As this technique becomes more popular, focusing on appropriate technique and interpretation is important. This article reviews the current and potential roles of CESM. It provides examples of CESM utilized for diagnostic indications while highlighting diagnostic dilemmas, pitfalls, and artifacts that may be encountered when interpreting CESM images.
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Affiliation(s)
- Kathryn Zamora
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America.
| | - Elizabeth Allen
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America
| | - Brittany Hermecz
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America
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Goh Y, Chan CW, Pillay P, Lee HS, Pan HB, Hung BH, Quek ST, Chou CP. Architecture distortion score (ADS) in malignancy risk stratification of architecture distortion on contrast-enhanced digital mammography. Eur Radiol 2020; 31:2657-2666. [PMID: 33125555 PMCID: PMC8043942 DOI: 10.1007/s00330-020-07395-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/15/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop a risk predictor model in evaluation of tomosynthesis-detected architectural distortion (AD) based on characteristics of contrast-enhanced digital mammography (CEDM). METHODS Ninety-four AD lesions on CEDM in combination with tomosynthesis were retrospectively reviewed from 92 consecutive women (mean age, 52.4 years ± 7.9) with abnormal diagnostic or screening mammography. CEDM results were correlated with histology of ADs using cross-tabulation for statistical analysis. Predictors for risk of malignancy from CEDM characteristics (background parenchyma enhancement, degree of AD enhancement, enhancing morphology, size of enhancement, and enhancing spiculations) and patient's age were evaluated using logistic regression. We propose a sum score, termed AD score (ADS), for risk stratification and corresponding suggested BI-RADS category. RESULTS Thirty-three of ninety-four (35.1%) of detected AD lesions were malignant. The sensitivity, specificity, PPV, and NPV of CEDM in evaluation of malignant AD are 100%, 42.6%, 48.5%, and 100%, respectively. Absence of AD enhancement on CEDM is highly indicative of no underlying malignancy. On multivariate analysis, the predictors on CEDM with statistical significance are (1) marked intensity of AD enhancement (OR, 22.6; 95%CI 3.1, 166.6; p = .002); and (2) presence of enhancing spiculations (OR, 9.1; 95%CI 2.2, 36.5; p = .002). A prediction model whose scores (ADS) given by ranking of OR of all predictors with AUC of 0.934 and Brier score of 0.0956 was developed. CONCLUSION ADS-based lesion characterization on CEDM enables risk assessment of tomosynthesis-detected AD lesions. KEY POINTS • Architecture distortions presenting with marked enhancement intensity and presence of enhancing spiculations are highly associated with risk of malignancy. • Absence of architecture distortion enhancement in minimal or mild background parenchyma enhancement on CEDM indicates low risk of breast malignancy (NPV = 100%).
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Affiliation(s)
- Yonggeng Goh
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
| | - Ching Wan Chan
- Department of Breast Surgery, National University Hospital, Singapore, Singapore
| | - Premilla Pillay
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bao-Hui Hung
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan.
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Covington MF. Contrast-Enhanced Mammography Implementation, Performance, and Use for Supplemental Breast Cancer Screening. Radiol Clin North Am 2020; 59:113-128. [PMID: 33222993 DOI: 10.1016/j.rcl.2020.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology that provides recombined contrast-enhanced images of the breast in addition to low-energy images analogous to a 2-dimensional full-field digital mammogram. Because most breast imaging centers do not use CEM at this time, a detailed overview of CEM implementation and performance is presented. Thereafter, the potential use of CEM for supplemental screening is discussed in detail, given the importance of this topic for the future of the CEM community. Diagnostic performance, safety, and cost considerations of CEM for dense breast tissue supplemental screening are discussed.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
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25
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Samreen N, Moy L, Lee CS. Architectural Distortion on Digital Breast Tomosynthesis: Management Algorithm and Pathological Outcome. JOURNAL OF BREAST IMAGING 2020; 2:424-435. [PMID: 38424901 DOI: 10.1093/jbi/wbaa034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Indexed: 03/02/2024]
Abstract
Architectural distortion on digital breast tomosynthesis (DBT) can occur due to benign and malignant causes. With DBT, there is an increase in the detection of architectural distortion compared with 2D digital mammography, and the positive predictive value is high enough to justify tissue sampling when imaging findings are confirmed. Workup involves supplemental DBT views and ultrasound, with subsequent image-guided percutaneous biopsy using the modality on which it is best visualized. If architectural distortion is subtle and/or questionable on diagnostic imaging, MRI may be performed for problem solving, with subsequent biopsy of suspicious findings using MRI or DBT guidance, respectively. If no suspicious findings are noted on MRI, a six-month follow-up DBT may be performed. On pathology, malignant cases are noted in 6.8%-50.7% of the cases, most commonly due to invasive ductal carcinoma, followed by invasive lobular carcinoma. Radial scars are the most common benign cause, with stromal fibrosis and sclerosing adenosis being much less common. As there is an increase in the number of benign pathological outcomes for architectural distortion on DBT compared with 2D digital mammography, concordance should be based on the level of suspicion of imaging findings. As discordant cases have upgrade rates of up to 25%, surgical consultation is recommended for discordant radiologic-pathologic findings.
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Affiliation(s)
- Naziya Samreen
- NYU Langone Medical Center, Department of Radiology, Garden City, NY
| | - Linda Moy
- NYU Grossman School of Medicine, Department of Radiology, New York, NY
| | - Cindy S Lee
- NYU Langone Medical Center, Department of Radiology, Garden City, NY
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Malignant Outcomes of Architectural Distortion on Tomosynthesis: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 217:295-303. [PMID: 32966111 DOI: 10.2214/ajr.20.23935] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. The literature has reported varying rates of malignancy for architectural distortion (AD) on digital breast tomosynthesis (DBT). OBJECTIVE. The purpose of this study was to evaluate the PPV for malignancy of AD on DBT without a known cause and to assess the presence of an ultrasound (US) correlate for malignant AD through systematic review and meta-analysis of the literature. EVIDENCE ACQUISITION. This meta-analysis included all studies published in Em-base, MEDLINE, and Evidence-Based Medicine Reviews databases through July 15, 2020, that assessed the rate of malignancy in patients with AD on DBT without a known cause that was deemed BI-RADS category 4 or 5. Rates of benign or high-risk lesions and the presence of a US correlate for malignant AD were assessed. Core needle biopsy or surgical pathology was used as the reference standard for lesion diagnosis. The pooled PPV and 95% CI were estimated using a random-effects model. EVIDENCE SYNTHESIS. Thirteen retrospective, observational studies were included, yielding 857 ADs seen on DBT. Of the 857 ADs, 339 were breast malignancies, yielding a pooled PPV for malignancy of 34.6% (95% CI, 24.5-46.3%). The pooled PPV for invasive malignancy was 34% (95% CI, 25-45%) and for ductal carcinoma in situ was 5% (95% CI, 4-7%). Of the 857 ADs, 235 (27.4%) were benign lesions, 282 (32.9%) were high-risk lesions, and 1 (0.1%) was a nonbreast metastatic lesion. From the studies that assessed for US correlates, 217 of 277 malignant ADs (78.3%) had a US correlate. CONCLUSION. The pooled PPV for malignancy of AD on DBT without a known cause is high at 34.6%, warranting tissue sampling. CLINICAL IMPACT. A needle biopsy should be performed for ADs on DBT without a known cause. Because most malignant distortions have a corresponding finding on US, a US examination should be performed to look for a correlate, but the absence of a correlate does not obviate a biopsy.
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Liu Y, Zhao S, Huang J, Zhang X, Qin Y, Zhong H, Yu J. Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography. Sci Rep 2020; 10:9807. [PMID: 32555338 PMCID: PMC7299980 DOI: 10.1038/s41598-020-66501-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/11/2020] [Indexed: 02/05/2023] Open
Abstract
CESM is an emerging digital mammography technology with a high breast cancer detection and a limited diagnostic specificity. In order to improve specificity, we quantitatively assessed enhancement intensity of breast lesions with different pathological types and hormonal receptor status and evaluated the consistency of enhancement patterns between CESM and DCE-MRI. A total of 145 lesions were enrolled, consisting of 43 malignant (17 non-infiltrating cancers and 26 infiltrating cancers) and 99 benign lesions. The diagnostic performance of enhancement intensity in the former positions was significantly higher than that in the latter positions (AUC: 0.834 vs. 0.755, p = 0.0008). Infiltrating cancers showed the highest enhancement intensity, while benign lesions the lowest (mean CNR1: 7.6% vs. 2.7%; median CNR1: 6.8% vs. 2.7%). Enhancement intensity of ER or PR positive group was weaker than negative group, while HER-2 positive group was stronger than negative group. 28 patients with 28 lesions performed both CESM and DCE-MRI examinations, showing a coincidence rate of 64.2% and moderate agreement (k = 0.515) between CESM and DCE-MRI. In conclusion, quantitative analysis of enhancement characteristics is feasible to the diagnosis practice on CESM.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Shuang Zhao
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Juan Huang
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xueqin Zhang
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yun Qin
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Huanhuan Zhong
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Jianqun Yu
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
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Ghaderi KF, Phillips J, Perry H, Lotfi P, Mehta TS. Contrast-enhanced Mammography: Current Applications and Future Directions. Radiographics 2019; 39:1907-1920. [DOI: 10.1148/rg.2019190079] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kimeya F. Ghaderi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Jordana Phillips
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Hannah Perry
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Parisa Lotfi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Tejas S. Mehta
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
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Travieso-Aja M, Maldonado-Saluzzi D, Naranjo-Santana P, Fernández-Ruiz C, Severino-Rondón W, Rodríguez Rodríguez M, Luzardo O. Evaluation of the applicability of BI-RADS® MRI for the interpretation of contrast-enhanced digital mammography. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Travieso-Aja M, Maldonado-Saluzzi D, Naranjo-Santana P, Fernández-Ruiz C, Severino-Rondón W, Rodríguez Rodríguez M, Luzardo O. Evaluación de la aplicabilidad del léxico BI-RADS® de la resonancia magnética para la interpretación de la mamografía digital con contraste. RADIOLOGIA 2019; 61:477-488. [DOI: 10.1016/j.rx.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 04/11/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022]
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Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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Alexander S, Dulku G, Hashoul S, Taylor DB. Practical uses of contrast-enhanced spectral mammography in daily work: A pictorial review. J Med Imaging Radiat Oncol 2019; 63:473-478. [PMID: 31332941 DOI: 10.1111/1754-9485.12927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
Contrast-enhanced spectral mammography (CESM) has a number of uses including the work-up of inconclusive findings on mammography, assessment of breast symptoms, cancer staging, evaluation of response to neoadjuvant chemotherapy and recently as an alternative to magnetic resonance imaging (MRI) in high-risk screening. CESM can be swiftly incorporated into the workflow of busy breast clinics. We share our experiences with CESM at a large breast assessment centre in Western Australia.
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Affiliation(s)
- Sweeka Alexander
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Gurjeet Dulku
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sharbell Hashoul
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM): a retrospective study involving 644 breast lesions. Radiol Med 2019; 124:1006-1017. [PMID: 31250270 DOI: 10.1007/s11547-019-01056-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of contrast-enhanced dual-energy spectral mammography (CESM) in comparison with that of full-field digital mammography (FFDM), either alone or accompanied with breast ultrasound (BUS) in a large series of patients/breast lesions (n = 644). PATIENTS AND METHODS In this retrospective study, five radiologists evaluated the lesions by three imaging modalities: FFDM, FFDM + BUS, and CESM and compared the imaging to the gold standard (histopathology or clinical follow-up). Diagnostic performance parameters and receiver operating characteristic (ROC) curves of CESM were calculated and compared to those of FFDM or FFDM + BUS (McNemar's test). Additionally, the reliability of tumor size measurement by CESM was compared with the histopathological measurement. RESULTS The study included 218 benign and 426 malignant lesions. 85% of benign and 93% of malignant lesions were adequately identified using CESM. With respect to FFDM and FFDM + BUS, CESM significantly increased sensitivity to 93.2% (+ 10.7% and + 3.4%, respectively); specificity to 84.4% (+ 15.8% and + 1.7%, respectively); PPV to 92.3% (+ 26.8% and + 3.6%, respectively); NPV to 86.0% (+ 1.6% and + 1.8%, respectively); and accuracy to 90.2% (+ 15.8% and + 3.2%, respectively). In the ROC curves analyses, the comparison among the three AUC values was also statistically significant (p < 0.001). Good agreement between tumor diameters measured using CESM and histopathology was observed (Spearman's rank correlation, r = 0.891, p < 0.0001), although this technique tended to produce an overestimation of the size (+ 7 mm). CONCLUSIONS CESM has high diagnostic accuracy and can be considered as a useful technique for the assessment of breast lesions.
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Phillips J, Fein-Zachary VJ, Slanetz PJ. Pearls and Pitfalls of Contrast-Enhanced Mammography. JOURNAL OF BREAST IMAGING 2019; 1:64-72. [PMID: 38424880 DOI: 10.1093/jbi/wby013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Contrast-enhanced mammography (CEM) is a promising new imaging modality that uses a dual-energy acquisition to provide both morphologic and vascular assessment of breast lesions. Although no official BI-RADS lexicon exists, interpretation entails using the mammographic BI-RADS lexicon in combination with that for breast MRI. CEM has comparable performance to breast MRI, with sensitivity of 93-100% and specificity of 80-94%. Currently FDA approved for diagnostic imaging, this technology can be helpful in determining disease extent in patients with newly diagnosed breast malignancy, monitoring response to neoadjuvant therapy, identifying mammographically occult malignancies, and diagnostic problem-solving. Studies are ongoing about its role in screening, especially in women with dense breasts or at elevated risk. There are some challenges to successful implementation into practice, but overall, patients tolerate the study well, and exam times are less than the full breast MRI protocol.
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Affiliation(s)
- Jordana Phillips
- Beth Israel Deaconess Medical Center, Department of Diagnostic Radiology, Boston, MA
| | | | - Priscilla J Slanetz
- Beth Israel Deaconess Medical Center, Department of Diagnostic Radiology, Boston, MA
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Contrast-Enhanced Mammography: A Systematic Guide to Interpretation and Reporting. AJR Am J Roentgenol 2019; 212:222-231. [DOI: 10.2214/ajr.17.19265] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lobbes M, Mulder H, Rousch M, Backes W, Wildberger J, Jeukens C. Quantification of enhancement in contrast-enhanced spectral mammography using a custom-made quantifier tool (I-STRIP): A proof-of-concept study. Eur J Radiol 2018; 106:114-121. [DOI: 10.1016/j.ejrad.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
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Zhu X, Huang JM, Zhang K, Xia LJ, Feng L, Yang P, Zhang MY, Xiao W, Lin HX, Yu YH. Diagnostic Value of Contrast-Enhanced Spectral Mammography for Screening Breast Cancer: Systematic Review and Meta-analysis. Clin Breast Cancer 2018; 18:e985-e995. [PMID: 29983379 DOI: 10.1016/j.clbc.2018.06.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/09/2018] [Accepted: 06/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contrast-enhanced spectral mammography (CESM) is a new image examination technology that has developed over the past few years. As CESM technology keeps improving, a current meta-analysis review is needed to systematically evaluate the potential diagnostic value of CESM. METHODS A total of 18 studies were included in the review. Sensitivity, specificity, and other important parameters of CESM accuracy for breast cancer diagnosis were pooled and analyzed using random-effects models. Summary receiver operating characteristic curves were calculated for overall accuracy estimation. RESULTS The summary estimates for CESM in the diagnosis of breast cancer were as follows: the pooled sensitivity and specificity were 0.89 (95% confidence interval [CI], 0.88-0.91) and 0.84 (95% CI, 0.82-0.85), respectively. Positive likelihood ratio was 3.73 (95% CI, 2.68-5.20), negative likelihood ratio was 0.10 (95% CI, 0.06-0.15), and diagnostic odds ratio was 71.36 (95% CI, 36.28-140.39). The area under the curve was 0.96 (standard error = 0.011). CONCLUSION CESM has a high diagnostic accuracy for evaluating breast cancer and can be considered as a useful test for initial assessment of breast lesions.
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Affiliation(s)
- Xiao Zhu
- Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, PR China
| | - Jun-Ming Huang
- Department of Oncology, Panyu Hospital of Chinese Medicine, Guangdong, PR China
| | - Kun Zhang
- Deparment of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong, PR China
| | - Long-Jie Xia
- Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, PR China
| | - Lan Feng
- National Center for Protein Sciences, Beijing, PR China
| | - Ping Yang
- Department of Oncology, Panyu Hospital of Chinese Medicine, Guangdong, PR China
| | - Meng-Ya Zhang
- Graduate School of Guangxi Medical University, Guangxi, PR China
| | - Wei Xiao
- Graduate School of Guangxi Medical University, Guangxi, PR China
| | - Hui-Xia Lin
- Graduate School of Guangxi Medical University, Guangxi, PR China
| | - Ying-Hua Yu
- Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, PR China.
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