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Shang H, Wu Q, Wu J, Zhou S, Wang Z, Wang H, Yin J. Study on breast cancerization and isolated diagnosis in situ by HOF-ATR-MIR spectroscopy with deep learning. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 319:124546. [PMID: 38824755 DOI: 10.1016/j.saa.2024.124546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
Mid-infrared (MIR) spectroscopy can characterize the content and structural changes of macromolecular components in different breast tissues, which can be used for feature extraction and model training by machine learning to achieve accurate classification and recognition of different breast tissues. In parallel, the one-dimensional convolutional neural network (1D-CNN) stands out in the field of deep learning for its ability to efficiently process sequential data, such as spectroscopic signals. In this study, MIR spectra of breast tissue were collected in situ by coupling the self-developed MIR hollow optical fiber attenuated total reflection (HOF-ATR) probe with a Fourier transform infrared spectroscopy (FTIR) spectrometer. Staging analysis was conducted on the changes in macromolecular content and structure in breast cancer tissues. For the first time, a trinary classification model was established based on 1D-CNN for recognizing normal, paracancerous and cancerous tissues. The final predication results reveal that the 1D-CNN model based on baseline correction (BC) and data augmentation yields more precise classification results, with a total accuracy of 95.09%, exhibiting superior discrimination ability than machine learning models of SVM-DA (90.00%), SVR (88.89%), PCA-FDA (67.78%) and PCA-KNN (70.00%). The experimental results suggest that the application of 1D-CNN enables accurate classification and recognition of different breast tissues, which can be considered as a precise, efficient and intelligent novel method for breast cancer diagnosis.
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Affiliation(s)
- Hui Shang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Qingxia Wu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Jinjin Wu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Suwei Zhou
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Zihan Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Huijie Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China.
| | - Jianhua Yin
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China.
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Pötsch N, Clauser P, Kapetas P, Baykara Ulusan M, Helbich T, Baltzer P. Enhancing the Kaiser score for lesion characterization in unenhanced breast MRI. Eur J Radiol 2024; 176:111520. [PMID: 38820953 DOI: 10.1016/j.ejrad.2024.111520] [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: 04/04/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To adapt the methodology of the Kaiser score, a clinical decision rule for lesion characterization in breast MRI, for unenhanced protocols. METHOD In this retrospective IRB-approved cross-sectional study, we included 93 consecutive patients who underwent breast MRI between 2021 and 2023 for further work-up of BI-RADS 0, 3-5 in conventional imaging or for staging purposes (BI-RADS 6). All patients underwent biopsy for histologic verification or were followed for a minimum of 12 months. MRI scans were conducted using 1.5 T or 3 T scanners using dedicated breast coils and a protocol in line with international recommendations including DWI and ADC. Lesion characterization relied solely on T2w and DWI/ADC-derived features (such as lesion type, margins, shape, internal signal, surrounding tissue findings, ADC value). Statistical analysis was done using decision tree analysis aiming to distinguish benign (histology/follow-up) from malignant outcomes. RESULTS We analyzed a total of 161 lesions (81 of them non-mass) with a malignancy rate of 40%. Lesion margins (spiculated, irregular, or circumscribed) were identified as the most important criterion within the decision tree, followed by the ADC value as second most important criterion. The resulting score demonstrated a strong diagnostic performance with an AUC of 0.840, providing both rule-in and rule-out criteria. In an independent test set of 65 lesions the diagnostic performance was verified by two readers (AUC 0.77 and 0.87, kappa: 0.62). CONCLUSIONS We developed a clinical decision rule for unenhanced breast MRI including lesion margins and ADC value as the most important criteria, achieving high diagnostic accuracy.
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Affiliation(s)
- N Pötsch
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Baykara Ulusan
- Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Org. Abdurrahman Nafiz Gurman Cad, No:1 Fatih, İstanbul, Turkey
| | - T Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - P Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Verboven G, Van den Bosch L, Lodewijkx I, Huizing M, Van Goethem M, Broeckx G, Tjalma WA. Retrospective cohort study on the bilateral occurrence of invasive lobular breast cancer. Eur J Obstet Gynecol Reprod Biol 2024; 298:175-181. [PMID: 38762954 DOI: 10.1016/j.ejogrb.2024.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Invasive lobular carcinoma (ILC) is the second most common histological subtype of invasive breast cancer, following the no special type (NST) invasive carcinoma. It has historically been assumed that ILC occurs bilaterally in 20-29 % of cases, which has influenced the inclusion of MRI in the standard workup of ILC according to European guidelines. However, challenging this long-held belief regarding the bilateral occurrence of ILC opens up the possibility of revising the guidelines and using MRI only for more specific indications. This study aims to evaluate whether the previously reported high percentage of bilaterality still holds true and to question the added value of MRI in the standard workup of ILC. STUDY DESIGN A retrospective cohort study was conducted following approval from the institutional review board (EC 21/18/249) at Antwerp University Hospital (UZA). The cohort comprised female patients of all ages who had been diagnosed with either ILC or NST invasive carcinoma and had sought consultation at the UZA breast clinic. A comprehensive database was established to collect information on patient characteristics, imaging, and pathology. RESULTS A total of 271 patients with ILC were included in the study, with incidence dates ranging from 01/01/2007 to 01/01/2023. Among these patients, a synchronous bilateral ILC lesion was observed in 1.85 % (5/271) of cases. This proportion is significantly lower than the reported percentage of patients with a bilateral lesion in the literature population, which stands at 4.95 %. The reference group consisted of 809 patients with NST invasive carcinoma, with incidence dates ranging from 01/01/2017 to 01/01/2023. In the control group, a synchronous bilateral NST lesion was observed in 3.96 % (32/809) of cases. There is no significant difference in the bilaterality rates between the group of ILC patients and the group of NST patients. Furthermore, MRI did not detect any histopathologically confirmed contralateral ILC lesion that had not already been detected by mammography or ultrasound. CONCLUSIONS The study results indicate a lower occurrence of bilateral ILC than previously assumed. Additionally, the incidence of synchronous bilateral lesions in ILC patients is not higher compared to patients with NST invasive carcinoma. Performing an MRI does not provide additional value in detecting bilateral carcinomas in ILC. Consequently, it is recommended that the current European guidelines be reassessed, and the indications for undergoing an MRI should be adjusted accordingly.
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Affiliation(s)
- Griet Verboven
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Laura Van den Bosch
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Imke Lodewijkx
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Manon Huizing
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; Biobank Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Mireille Van Goethem
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; Multidisciplinary Breast Clinic-Unit Antwerp University Hospital, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Glenn Broeckx
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; Department of Pathology PA(2), GZA-ZNA Hospitals, Lindendreef 1, 2020 Antwerp, Belgium.
| | - Wiebren A Tjalma
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; Multidisciplinary Breast Clinic-Unit Antwerp University Hospital, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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Ma J, Hou L, Liang X, Yan B, Dai Q, Wang Y, Gao H, Zhu J, Song C, Yuan Q. Application value of MRI-guided wire localization to the non-palpable breast lesions only shown in Breast MRI. Front Oncol 2024; 14:1325362. [PMID: 38854734 PMCID: PMC11157007 DOI: 10.3389/fonc.2024.1325362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/30/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Magnetic resonance imaging (MRI)-guided wire localization can be applied to assist to remove suspected breast lesions accurately. This study aimed to evaluate the clinical application value of this technique in Chinese women. Methods A total of 126 patients (131 lesions) who had underwent such technique in our hospital from April 2017 to June 2023 were enrolled. 1.5T MRI system and a wire localization device were used. Image characteristics, clinical features and postoperative pathology were collected and analyzed. Results All of 126 patients (131 lesions) were successfully localized by MRI and excised for biopsy. There were 39 malignant lesions (29.77%) and 92 benign lesions (70.23%). There was no significant correlation between the morphology of DCE-MRI and the ratio of malignant lesions (P=0.763), while there was a statistical correlation between the BPE, TIC curve and the malignancy rate (P<0.05). All the lesions were assessed according to BI-RADS category of MRI (C4A=77, C4B=40, C4C=12, C5=2). The malignancy rates were as follows: 16.88% for 4A lesions (13/77), 37.50% for 4B lesions (15/40), 75.00% for 4C lesions (9/12) and 100% for 5 lesions (2/2). There was a significant correlation between the BI-RADS category and the incidence of benign-to-malignant lesions (P<0.001). Conclusion MRI-guided wire localization can assist to remove suspected breast lesions early, safely and accurately. This technique makes up for the deficiency of X-ray and ultrasound, improves the accuracy of diagnosis and resection therapy in intraductal carcinoma and early invasive carcinoma, and helps to improve the the prognosis of breast cancer.
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Affiliation(s)
- Jiaqi Ma
- Department of Radiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Leina Hou
- Department of Anesthesiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Xiufen Liang
- Department of Radiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Bin Yan
- Department of Radiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Qiang Dai
- Department of Radiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Yunmei Wang
- Department of Medical Oncology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Hongbian Gao
- Department of Pathology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Jiang Zhu
- Department of Breast Cancer, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Canxu Song
- Department of Ultrasonography, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
| | - Quan Yuan
- Department of Ultrasonography, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, China
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Rescinito G, Brunetti N, Garlaschi A, Tosto S, Gristina L, Conti B, Pieroni D, Calabrese M, Tagliafico AS. Long-term outcome of 9G MRI-guided vacuum-assisted breast biopsy: results of 293 single-center procedures and underestimation rate of high-risk lesions over 12 years. LA RADIOLOGIA MEDICA 2024; 129:767-775. [PMID: 38512628 PMCID: PMC11088538 DOI: 10.1007/s11547-024-01808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Breast magnetic resonance imaging (MRI) can detect some malignant lesions that are not visible on mammography (MX) or ultrasound (US). If a targeted, second-look fails, MRI-guided breast biopsy is the only available tool to obtain a tissue sample and pathological proof of these "MRI-only lesions". The aim of this study is to report the performance and underestimation rate of 9G MRI-guided vacuum-assisted breast biopsy (VABB) over 12 years at a single center. MATERIAL AND METHODS All 9G MRI-VABB procedures performed from January 2010 to December 2021 were retrospectively reviewed. Two MRI scanners (1.5 T and 3 T) were used with the same image resolution and contrast media. All suspicious lesions detected only by breast MRI underwent biopsy. Reference standard was histological diagnosis or at least 1-year negative follow-up. All malignant and atypical lesions underwent surgery, which was used as the reference standard. RESULTS A total of 293 biopsies were retrospectively reviewed. Histopathological VABB results revealed 142/293 (48.4%) benign lesions, 77/293 (26.2%) high-risk lesions, and 74/293 (25.2%) malignant lesions. No significant complications were observed. Surgical pathology results allowed for the reclassification of n = 7/48 B3b lesions: n = 4 were ductal carcinoma in situ, while n = 3 presented invasive features at surgical histology (2 IDC; 1 ILC). B3b underestimation occurred overall in 14.6% of B3 cases. Breast follow-up was achieved for all benign VABB results, and only one false-negative case was observed. CONCLUSION Our results confirm that 1.5 T and 3 T MRI-guided VABB is an accurate and safe procedure for histopathologic final diagnosis of MRI-only lesions. Critical issues remain the potential high-risk underestimation rate of B3b VABB results and management of follow-up of benign lesions.
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Affiliation(s)
- Giuseppe Rescinito
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Nicole Brunetti
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
- Department of Experimental Medicine (DIMES), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy.
| | - Alessandro Garlaschi
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Simona Tosto
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Licia Gristina
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Benedetta Conti
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Diletta Pieroni
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Massimo Calabrese
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Radiology, IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
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Pötsch N, Sodano C, Baltzer PAT. Performance of Diffusion-weighted Imaging-based Noncontrast MRI Protocols for Diagnosis of Breast Cancer: A Systematic Review and Meta-Analysis. Radiology 2024; 311:e232508. [PMID: 38771179 DOI: 10.1148/radiol.232508] [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: 05/22/2024]
Abstract
Background Diffusion-weighted imaging (DWI) is increasingly recognized as a powerful diagnostic tool and tested alternative to contrast-enhanced (CE) breast MRI. Purpose To perform a systematic review and meta-analysis that assesses the diagnostic performance of DWI-based noncontrast MRI protocols (ncDWI) for the diagnosis of breast cancer. Materials and Methods A systematic literature search in PubMed for articles published from January 1985 to September 2023 was performed. Studies were excluded if they investigated malignant lesions or selected patients and/or lesions only, used DWI as an adjunct technique to CE MRI, or were technical studies. Statistical analysis included pooling of diagnostic accuracy and investigating between-study heterogeneity. Additional subgroup comparisons of ncDWI to CE MRI and standard mammography were performed. Results A total of 28 studies were included, with 4406 lesions (1676 malignant, 2730 benign) in 3787 patients. The pooled sensitivity and specificity of ncDWI were 86.5% (95% CI: 81.4, 90.4) and 83.5% (95% CI: 76.9, 88.6), and both measures presented with high between-study heterogeneity (I 2 = 81.6% and 91.6%, respectively; P < .001). CE MRI (18 studies) had higher sensitivity than ncDWI (95.1% [95% CI: 92.9, 96.7] vs 88.9% [95% CI: 82.4, 93.1], P = .004) at similar specificity (82.2% [95% CI: 75.0, 87.7] vs 82.0% [95% CI: 74.8, 87.5], P = .97). Compared with ncDWI, mammography (five studies) showed no evidence of a statistical difference for sensitivity (80.3% [95% CI: 56.3, 93.3] vs 56.7%; [95% CI: 41.9, 70.4], respectively; P = .09) or specificity (89.9% [95% CI: 85.5, 93.1] vs 90% [95% CI: 61.3, 98.1], respectively; P = .62), but ncDWI had a higher area under the summary receiver operating characteristic curve (0.93 [95% CI: 0.91, 0.95] vs 0.78 [95% CI: 0.74, 0.81], P < .001). Conclusion A direct comparison with CE MRI showed a modestly lower sensitivity at similar specificity for ncDWI, and higher diagnostic performance indexes for ncDWI than standard mammography. Heterogeneity was high, thus these results must be interpreted with caution. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kataoka and Iima in this issue.
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Affiliation(s)
- Nina Pötsch
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Claudia Sodano
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Pascal A T Baltzer
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Endrikat J, Gutberlet M, Barkhausen J, Schöckel L, Bhatti A, Harz C, Hoffmann KT. Clinical Efficacy of Gadobutrol: Review of Over 25 Years of Use Exceeding 100 Million Administrations. Invest Radiol 2024; 59:345-358. [PMID: 37972293 DOI: 10.1097/rli.0000000000001041] [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: 11/19/2023]
Abstract
BACKGROUND Gadobutrol has been administered more than 100 million times worldwide, since February 1998, that is, over the last 25 years. Numerous clinical studies in a broad range of indications document the long-term experience with gadobutrol. OBJECTIVE The aim of this study was to provide a literature-based overview on gadobutrol's efficacy in 9 approved indications and use in children. MATERIALS AND METHODS Efficacy results in patients of all age groups including sensitivity, specificity, accuracy, and positive/negative predictive values were identified by a systematic literature search on Embase until December 31, 2022. Nine approved indications were considered: central nervous system (CNS), magnetic resonance angiography (MRA), breast, heart, prostate, kidney, liver, musculoskeletal, whole body, and various indications in children. RESULTS Sixty-five publications (10 phase III, 2 phase IV, 53 investigator-initiated studies) reported diagnostic efficacy results obtained from 7806 patients including 271 children, at 369 centers worldwide. Indication-specific sensitivity ranges were 59%-98% (CNS), 53%-100% (MRA), 80%-100% (breast), 64%-90% (heart), 64%-96% (prostate), 71-85 (kidney), 79%-100% (liver), 53%-98% (musculoskeletal), and 78%-100% (children). Indication-specific specificity ranges were 75%-100% (CNS), 64%-99% (MRA), 58%-98% (breast), and 47%-100% (heart). CONCLUSIONS The evaluated body of evidence, consisting of 65 studies with 7806 patients, including 271 children and 7535 adults, showed that gadobutrol is an efficacious magnetic resonance imaging contrast agent for all age groups in various approved indications throughout the whole body.
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Affiliation(s)
- Jan Endrikat
- From the Radiology, Bayer AG, Berlin, Germany (J.E., L.S., C.H.); Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany (J.E.); Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany (M.G.); Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein-Campus Luebeck, Luebeck, Germany (J.B.); Bayer US LLC, Benefit-Risk Management Pharmacovigilance, Whippany, NJ (A.B.); and Department of Neuroradiology, University of Leipzig, Leipzig, Germany (K.-T.H.)
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Marcon M, Fuchsjäger MH, Clauser P, Mann RM. ESR Essentials: screening for breast cancer - general recommendations by EUSOBI. Eur Radiol 2024:10.1007/s00330-024-10740-5. [PMID: 38656711 DOI: 10.1007/s00330-024-10740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/26/2024]
Abstract
Breast cancer is the most frequently diagnosed cancer in women accounting for about 30% of all new cancer cases and the incidence is constantly increasing. Implementation of mammographic screening has contributed to a reduction in breast cancer mortality of at least 20% over the last 30 years. Screening programs usually include all women irrespective of their risk of developing breast cancer and with age being the only determining factor. This approach has some recognized limitations, including underdiagnosis, false positive cases, and overdiagnosis. Indeed, breast cancer remains a major cause of cancer-related deaths in women undergoing cancer screening. Supplemental imaging modalities, including digital breast tomosynthesis, ultrasound, breast MRI, and, more recently, contrast-enhanced mammography, are available and have already shown potential to further increase the diagnostic performances. Use of breast MRI is recommended in high-risk women and women with extremely dense breasts. Artificial intelligence has also shown promising results to support risk categorization and interval cancer reduction. The implementation of a risk-stratified approach instead of a "one-size-fits-all" approach may help to improve the benefit-to-harm ratio as well as the cost-effectiveness of breast cancer screening. KEY POINTS: Regular mammography should still be considered the mainstay of the breast cancer screening. High-risk women and women with extremely dense breast tissue should use MRI for supplemental screening or US if MRI is not available. Women need to participate actively in the decision to undergo personalized screening. KEY RECOMMENDATIONS: Mammography is an effective imaging tool to diagnose breast cancer in an early stage and to reduce breast cancer mortality (evidence level I). Until more evidence is available to move to a personalized approach, regular mammography should be considered the mainstay of the breast cancer screening. High-risk women should start screening earlier; first with yearly breast MRI which can be supplemented by yearly or biennial mammography starting at 35-40 years old (evidence level I). Breast MRI screening should be also offered to women with extremely dense breasts (evidence level I). If MRI is not available, ultrasound can be performed as an alternative, although the added value of supplemental ultrasound regarding cancer detection remains limited. Individual screening recommendations should be made through a shared decision-making process between women and physicians.
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Affiliation(s)
- Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute of Radiology, Hospital Lachen, Oberdorfstrasse 41, 8853, Lachen, Switzerland.
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Ritse M Mann
- Department of Diagnostic Imaging, Radboud University Medical Centre, Geert Grotteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Demetriou D, Lockhat Z, Brzozowski L, Saini KS, Dlamini Z, Hull R. The Convergence of Radiology and Genomics: Advancing Breast Cancer Diagnosis with Radiogenomics. Cancers (Basel) 2024; 16:1076. [PMID: 38473432 DOI: 10.3390/cancers16051076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Despite significant progress in the prevention, screening, diagnosis, prognosis, and therapy of breast cancer (BC), it remains a highly prevalent and life-threatening disease affecting millions worldwide. Molecular subtyping of BC is crucial for predictive and prognostic purposes due to the diverse clinical behaviors observed across various types. The molecular heterogeneity of BC poses uncertainties in its impact on diagnosis, prognosis, and treatment. Numerous studies have highlighted genetic and environmental differences between patients from different geographic regions, emphasizing the need for localized research. International studies have revealed that patients with African heritage are often diagnosed at a more advanced stage and exhibit poorer responses to treatment and lower survival rates. Despite these global findings, there is a dearth of in-depth studies focusing on communities in the African region. Early diagnosis and timely treatment are paramount to improving survival rates. In this context, radiogenomics emerges as a promising field within precision medicine. By associating genetic patterns with image attributes or features, radiogenomics has the potential to significantly improve early detection, prognosis, and diagnosis. It can provide valuable insights into potential treatment options and predict the likelihood of survival, progression, and relapse. Radiogenomics allows for visual features and genetic marker linkage that promises to eliminate the need for biopsy and sequencing. The application of radiogenomics not only contributes to advancing precision oncology and individualized patient treatment but also streamlines clinical workflows. This review aims to delve into the theoretical underpinnings of radiogenomics and explore its practical applications in the diagnosis, management, and treatment of BC and to put radiogenomics on a path towards fully integrated diagnostics.
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Affiliation(s)
- Demetra Demetriou
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield, Pretoria 0028, South Africa
| | - Zarina Lockhat
- Department of Radiology, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Hatfield, Pretoria 0028, South Africa
| | - Luke Brzozowski
- Translational Research and Core Facilities, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Kamal S Saini
- Fortrea Inc., 8 Moore Drive, Durham, NC 27709, USA
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Zodwa Dlamini
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield, Pretoria 0028, South Africa
| | - Rodney Hull
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield, Pretoria 0028, South Africa
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10
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van Nijnatten TJA, Morscheid S, Baltzer PAT, Clauser P, Alcantara R, Kuhl CK, Wildberger JE. Contrast-enhanced breast imaging: Current status and future challenges. Eur J Radiol 2024; 171:111312. [PMID: 38237520 DOI: 10.1016/j.ejrad.2024.111312] [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: 12/21/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Contrast-enhanced breast MRI and recently also contrast-enhanced mammography (CEM) are available for breast imaging. The aim of the current overview is to explore existing evidence and ongoing challenges of contrast-enhanced breast imaging. METHODS This narrative provides an introduction to the contrast-enhanced breast imaging modalities breast MRI and CEM. Underlying principle, techniques and BI-RADS reporting of both techniques are described and compared, and the following indications and ongoing challenges are discussed: problem-solving, high-risk screening, supplemental screening in women with extremely dense breast tissue, breast implants, neoadjuvant systemic therapy (NST) response monitoring, MRI-guided and CEM- guided biopsy. RESULTS Technique and reporting for breast MRI are standardised, for the newer CEM standardisation is in progress. Similarly, compared to other modalities, breast MRI is well established as superior for problem-solving, screening women at high risk, screening women with extremely dense breast tissue or with implants; and for monitoring response to NST. Furthermore, MRI-guided biopsy is a reliable technique with low long-term false negative rates. For CEM, data is as yet either absent or limited, but existing results in these settings are promising. CONCLUSION Contrast-enhanced breast imaging achieves highest diagnostic performance and should be considered essential. Of the two contrast-enhanced modalities, evidence of breast MRI superiority is ample, and preliminary results on CEM are promising, yet CEM warrants further study.
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Affiliation(s)
- T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - S Morscheid
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - R Alcantara
- Radiology and Nuclear Medicine Department, Hospital del Mar, Barcelona, Spain
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
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11
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Su HZ, Huang M, Li ZY, Tu JH, Hong LC, Zhang ZB, Zhang XD. Ultrasound characteristics of breast fibromatosis mimicking carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:144-151. [PMID: 37991026 DOI: 10.1002/jcu.23613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To explore the value of ultrasound (US) characteristics in diagnosing breast fibromatosis (BF) and evaluate their differences from breast carcinoma. METHODS A total of 121 patients with BF (n = 24, 29 lesions) or invasive ductal carcinoma (IDC) (n = 97, 102 lesions) of the breast were included. Their clinical and US findings were recorded and analyzed. RESULTS The mean age of BF was younger than that of IDC (28.75 ± 5.55 vs. 50.19 ± 9.87, p < 0.001). The mean size of the BF was smaller than that of IDC (2.09 ± 0.91 vs. 2.71 ± 1.20, p = 0.011). Compared to IDC, BF had more frequency of posterior echo attenuation (p < 0.001), less frequency of peripheral hyperechoic halo (p = 0.002), calcification (p = 0.001), US reported axillary lymph node positive (p = 0.025), and grade 2-3 vascularity (p < 0.001). The Breast Imaging Reporting and Data System categorized BF at a lower level than IDC (p < 0.001). After adjusting for age, the peripheral hyperechoic halo, posterior echo feature, and vascularity could independently identify the differences between these two entities. CONCLUSION Some differences were observed between BF and IDC in terms of patient age, lesion size, and US characteristics.
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Affiliation(s)
- Huan-Zhong Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Mei Huang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhi-Yong Li
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jin-Hua Tu
- Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zuo-Bing Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Dong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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12
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Parisi S, Gambardella C, Ruggiero R, Tolone S, Iovino F, Lucido FS, Fisone F, Lanza Volpe M, Cozzolino G, Mongardini FM, Brusciano L, Andrea R, Docimo L. Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review. Oncol Lett 2024; 27:86. [PMID: 38249810 PMCID: PMC10797319 DOI: 10.3892/ol.2024.14220] [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: 07/12/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Cancers of unknown primary (CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis. The primitive tumor remains unknown, whereas metastases are the most common manifestation. Occult male breast cancers are very rare types of CUPs. The present study describes the case of a 64-year-old man affected by a CUP of presumed mammary origin. The aim of the article and the present review was to focus on their management. To the best of our knowledge, only thirteen cases have been reported in the literature. Because no specific guidelines are available, various approaches have been applied, influencing the treatment and the prognosis of patients with CUP.
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Affiliation(s)
- Simona Parisi
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Claudio Gambardella
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Roberto Ruggiero
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Salvatore Tolone
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Francesco Iovino
- Department of Translational Medical Science, School of Medicine, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Francesco Saverio Lucido
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Francesca Fisone
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Mariachiara Lanza Volpe
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Giovanni Cozzolino
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Federico Maria Mongardini
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Luigi Brusciano
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Ronchi Andrea
- Mental and Physical Health and Preventive Medicine Department, Pathology Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
| | - Ludovico Docimo
- Department of Advanced Science and Surgery, General, Mini-Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I-80138 Naples, Italy
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13
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Hong YJ, Han K, Lee HJ, Hur J, Kim YJ, Kim MJ, Choi BW. Assessment of Feasibility and Interscan Variability of Short-time Cardiac MRI for Cardiotoxicity Evaluation in Breast Cancer. Radiol Cardiothorac Imaging 2024; 6:e220229. [PMID: 38329404 PMCID: PMC10912882 DOI: 10.1148/ryct.220229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024]
Abstract
Purpose To investigate the feasibility and interscan variability of short-time cardiac MRI protocol after chemotherapy in individuals with breast cancer. Materials and Methods A total of 13 healthy female controls (mean age, 52.4 years ± 13.2 [SD]) and 85 female participants with breast cancer (mean age, 51.8 years ± 9.9) undergoing chemotherapy prospectively underwent routine breast MRI and short-time cardiac MRI using a 3-T scanner with peripheral pulse gating in the prone position. Interscan, intercoil, and interobserver reproducibility and variability of native T1 and extracellular volume (ECV), as well as ventricular functional parameters, were measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), or coefficient of variation (CoV). Results Left ventricular functional parameters had excellent interscan reproducibility (ICC ≥ 0.80). Left ventricular ejection fraction showed low interscan variability in control and chemotherapy participants (SEM, 2.0 and 1.2; CoV, 3.1 and 1.9, respectively). Native T1 showed excellent interscan (ICC, 0.75) and intercoil (ICC, 0.81) reproducibility in the control group and good interscan reproducibility (ICC, 0.72 and 0.73, respectively) in the participants undergoing immediate and remote chemotherapy. Interscan reproducibility for ECV was excellent in the control group and in the remote chemotherapy group (ICC, 0.93 and 0.88, respectively) and fair in the immediate chemotherapy group (ICC, 0.52). In the regional analysis, interscan repeatability and variability of native T1 and ECV were superior in the anteroseptum or inferoseptum than in other segments in the immediate chemotherapy group. Native T1 and ECV had good to excellent interobserver agreement across all groups. Conclusion Short-time cardiac MRI showed excellent results for interscan, intercoil, and interobserver reproducibility and variability for ventricular functional or tissue characterization parameters, suggesting that this modality is feasible for routine surveillance of cardiotoxicity evaluation in individuals with breast cancer. Keywords: Cardiac MRI, Heart, Cardiomyopathy ClinicalTrials.gov registration no. NCT03301389 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Yoo Jin Hong
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Kyunghwa Han
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Hye-Jeong Lee
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Jin Hur
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Young Jin Kim
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Min Jung Kim
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Byoung Wook Choi
- From the Department of Radiology and Research Institute of
Radiological Science, Severance Hospital, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
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14
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Tollens F, Baltzer PA, Froelich MF, Kaiser CG. Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses. Front Oncol 2023; 13:1292268. [PMID: 38130995 PMCID: PMC10733447 DOI: 10.3389/fonc.2023.1292268] [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: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Economic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening. Purpose To introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening. Materials and methods The various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed. Results Despite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes. Conclusion Economic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.
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Affiliation(s)
- Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal A.T. Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Clemens G. Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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15
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Dietzel M, Bernathova M, Clauser P, Kapetas P, Uder M, Baltzer PAT. Added value of clinical decision rules for the management of enhancing breast MRI lesions: A systematic comparison of the Kaiser score and the Göttingen score. Eur J Radiol 2023; 169:111185. [PMID: 37939606 DOI: 10.1016/j.ejrad.2023.111185] [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: 08/17/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE We investigated the added value of two internationally used clinical decision rules in the management of enhancing lesions on breast MRI. METHODS This retrospective, institutional review board approved study included consecutive patients from two different populations. Patients received breast MRI according to the recommendations of the European Society of Breast Imaging (EUSOBI). Initially, all examinations were assessed by expert readers without using clinical decision rules. All lesions rated as category 4 or 5 according to the Breast Imaging Reporting and Data System were histologically confirmed. These lesions were re-evaluated by an expert reader blinded to the histology. He assigned each lesion a Göttingen score (GS) and a Kaiser score (KS) on different occasions. To provide an estimate on inter-reader agreement, a second fellowship-trained reader assessed a subset of these lesions. Subgroup analyses based on lesion type (mass vs. non-mass), size (>1 cm vs. ≤ 1 cm), menopausal status, and significant background parenchymal enhancement were conducted. The areas under the ROC curves (AUCs) for the GS and KS were compared, and the potential to avoid unnecessary biopsies was determined according to previously established cutoffs (KS > 4, GS > 3) RESULTS: 527 lesions in 506 patients were included (mean age: 51.8 years, inter-quartile-range: 43.0-61.0 years). 131/527 lesions were malignant (24.9 %; 95 %-confidence-interval: 21.3-28.8). In all subgroups, the AUCs of the KS (median = 0.91) were higher than those of the GS (median = 0.83). Except for "premenopausal patients" (p = 0.057), these differences were statistically significant (p ≤ 0.01). Kappa agreement was higher for the KS (0.922) than for the GS (0.358). CONCLUSION Both the KS and the GS provided added value for the management of enhancing lesions on breast MRI. The KS was superior to the GS in terms of avoiding unnecessary biopsies and showed superior inter-reader agreement; therefore, it may be regarded as the clinical decision rule of choice.
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Affiliation(s)
- Matthias Dietzel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer-Guertel 18-20, Vienna, Austria.
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16
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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Gerardi MA, Fodor C, Rondi E, Vigorito S, Penco S, Sargenti M, Baratella P, Vicini E, Morigi C, Kahler-Ribeiro-Fontana S, Galimberti VE, Gandini S, De Camilli E, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. A narrative review for radiation oncologists to implement preoperative partial breast irradiation. LA RADIOLOGIA MEDICA 2023; 128:1553-1570. [PMID: 37650981 DOI: 10.1007/s11547-023-01706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
The strategy to anticipate radiotherapy (RT) before surgery, for breast cancer (BC) treatment, has recently generated a renewed interest. Historically, preoperative RT has remained confined either to highly selected patients, in the context of personalized therapy, or to clinical research protocols. Nevertheless, in the recent years, thanks to technological advances and increased tumor biology understanding, RT has undergone great changes that have also impacted the preoperative settings, embracing the modern approach to breast cancer. In particular, the reappraisal of preoperative RT can be viewed within the broader view of personalized and tailored medicine. In fact, preoperative accelerated partial breast irradiation (APBI) allows a more precise target delineation, with less variability in contouring among radiation oncologists, and a smaller treatment volume, possibly leading to lower toxicity and to dose escalation programs. The aim of the present review, which represents a benchmark study for the AIRC IG-23118, is to report available data on different technical aspects of preoperative RT including dosimetric studies, patient's selection and set-up, constraints, target delineation and clinical results. These data, along with the ones that will become available from ongoing studies, may inform the design of the future trials and representing a step toward a tailored APBI approach with the potential to challenge the current treatment paradigm in early-stage BC.Trial registration: The study is registered at clinicaltrials.gov (NCT04679454).
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Affiliation(s)
- Maria Alessia Zerella
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Mattia Zaffaroni
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giuseppe Ronci
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | | | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Penco
- Division of Breast Radiology, IRCSS, IEO European Institute of Oncology, Milan, Italy
| | - Manuela Sargenti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Baratella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa Vicini
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Consuelo Morigi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa De Camilli
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Renne
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Maria Cristina Leonardi
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
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17
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Wong SM. Best practice & research clinical haematology: Screening for breast cancer in hodgkin lymphoma survivors. Best Pract Res Clin Haematol 2023; 36:101525. [PMID: 38092481 DOI: 10.1016/j.beha.2023.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
Childhood and young adult survivors of Hodgkin lymphoma are at an elevated risk of developing breast cancer. Breast cancer risk is felt to originate from chest wall radiation exposure prior to the third decade of life, with incidence beginning to rise approximately eight to ten years following Hodgkin lymphoma treatment. Although incidence varies according to age at radiation exposure, dosage, and treatment fields, cohort studies have documented a cumulative incidence of breast cancer of 10-20% by 40 years of age. Women with a history of chest radiation for Hodgkin lymphoma are counselled to begin screening with bilateral breast MRI at 25 years of age, or eight years after radiation, whichever occurs later. Outside of high-risk surveillance, the optimal management approach for women with prior radiation exposure continues to evolve. When diagnosed with breast malignancy, evidence supports consideration of unilateral therapeutic and contralateral prophylactic mastectomy, although breast conserving surgery may be considered following multidisciplinary assessment. This review will address the epidemiology, characteristics, screening and management guidelines, and breast-cancer prevention efforts for Hodgkin lymphoma survivors treated with radiation therapy in adolescence and young adulthood.
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Affiliation(s)
- Stephanie M Wong
- Department of Surgery and Oncology, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada.
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18
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Isaieva K, Meullenet C, Vuissoz P, Fauvel M, Nohava L, Laistler E, Zeroual MA, Henrot P, Felblinger J, Odille F. Feasibility of online non-rigid motion correction for high-resolution supine breast MRI. Magn Reson Med 2023; 90:2130-2143. [PMID: 37379467 PMCID: PMC10953366 DOI: 10.1002/mrm.29768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Conventional breast MRI is performed in the prone position with a dedicated coil. This allows high-resolution images without breast motion, but the patient position is inconsistent with that of other breast imaging modalities or interventions. Supine breast MRI may be an interesting alternative, but respiratory motion becomes an issue. Motion correction methods have typically been performed offline, for instance, the corrected images were not directly accessible from the scanner console. In this work, we seek to show the feasibility of a fast, online, motion-corrected reconstruction integrated into the clinical workflow. METHODS Fully sampled T2 -weighted (T2 w) and accelerated T1 -weighted (T1 w) breast supine MR images were acquired during free-breathing and were reconstructed using a non-rigid motion correction technique (generalized reconstruction by inversion of coupled systems). Online reconstruction was implemented using a dedicated system combining the MR raw data and respiratory signals from an external motion sensor. Reconstruction parameters were optimized on a parallel computing platform, and image quality was assessed by objective metrics and by radiologist scoring. RESULTS Online reconstruction time was 2 to 2.5 min. The metrics and the scores related to the motion artifacts significantly improved for both T2 w and T1 w sequences. The overall quality of T2 w images was approaching that of the prone images, whereas the quality of T1 w images remained significantly lower. CONCLUSION The proposed online algorithm allows a noticeable reduction of motion artifacts and an improvement of the diagnostic quality for supine breast imaging with a clinically acceptable reconstruction time. These findings serve as a starting point for further development aimed at improving the quality of T1 w images.
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Affiliation(s)
| | - Camille Meullenet
- Institut de Cancérologie de Lorraine Alexis VautrinVandoeuvre‐les‐NancyFrance
| | | | - Marc Fauvel
- CIC‐IT 1433, INSERM, CHRU de NancyNancyFrance
| | - Lena Nohava
- High Field MR Center, Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Elmar Laistler
- High Field MR Center, Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | | | - Philippe Henrot
- Institut de Cancérologie de Lorraine Alexis VautrinVandoeuvre‐les‐NancyFrance
| | - Jacques Felblinger
- IADI, Université de Lorraine, INSERM U1254NancyFrance
- CIC‐IT 1433, INSERM, CHRU de NancyNancyFrance
| | - Freddy Odille
- IADI, Université de Lorraine, INSERM U1254NancyFrance
- CIC‐IT 1433, INSERM, CHRU de NancyNancyFrance
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19
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Sassi A, Salminen A, Jukkola A, Tervo M, Mäenpää N, Turtiainen S, Tiainen L, Liimatainen T, Tolonen T, Huhtala H, Rinta-Kiikka I, Arponen O. Breast density and the likelihood of malignant MRI-detected lesions in women diagnosed with breast cancer. Eur Radiol 2023; 33:8080-8088. [PMID: 37646814 PMCID: PMC10598189 DOI: 10.1007/s00330-023-10072-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/04/2023] [Accepted: 06/30/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To assess whether mammographic breast density in women diagnosed with breast cancer correlates with the total number of incidental magnetic resonance imaging (MRI)-detected lesions and the likelihood of the lesions being malignant. METHODS Patients diagnosed with breast cancer meeting the EUSOBI and EUSOMA criteria for preoperative breast MRI routinely undergo mammography and ultrasound before MRI at our institution. Incidental suspicious breast lesions detected in MRI are biopsied. We included patients diagnosed with invasive breast cancers between 2014 and 2019 who underwent preoperative breast MRI. One reader retrospectively determined breast density categories according to the 5th edition of the BI-RADS lexicon. RESULTS Of 946 patients with 973 malignant primary breast tumors, 166 (17.5%) had a total of 175 (18.0%) incidental MRI-detected lesions (82 (46.9%) malignant and 93 (53.1%) benign). High breast density according to BI-RADS was associated with higher incidence of all incidental enhancing lesions in preoperative breast MRIs: 2.66 (95% confidence interval: 1.03-6.86) higher for BI-RADS density category B, 2.68 (1.04-6.92) for category C, and 3.67 (1.36-9.93) for category D compared to category A (p < 0.05). However, high breast density did not predict higher incidence of malignant incidental lesions (p = 0.741). Incidental MRI-detected lesions in the contralateral breast were more likely benign (p < 0.001): 18 (27.3%)/48 (72.7%) vs. 64 (58.7%)/45 (41.3%) malignant/benign incidental lesions in contralateral vs. ipsilateral breasts. CONCLUSION Women diagnosed with breast cancer who have dense breasts have more incidental MRI-detected lesions, but higher breast density does not translate to increased likelihood of malignant incidental lesions. CLINICAL RELEVANCE STATEMENT Dense breasts should not be considered as an indication for preoperative breast MRI in women diagnosed with breast cancer. KEY POINTS • The role of preoperative MRI of patients with dense breasts diagnosed with breast cancer is under debate. • Women with denser breasts have a higher incidence of all MRI-detected incidental breast lesions, but the incidence of malignant MRI-detected incidental lesions is not higher than in women with fatty breasts. • High breast density alone should not indicate preoperative breast MRI.
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Affiliation(s)
- Antti Sassi
- Department of Radiology, Tampere University Hospital, Elämänaukio 1, 33520, Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Annukka Salminen
- Department of Radiology, Tampere University Hospital, Elämänaukio 1, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arja Jukkola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Maija Tervo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Niina Mäenpää
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Saara Turtiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Leena Tiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging Physics and Technology, University of Oulu, Oulu, Finland
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - Teemu Tolonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Tampere University Hospital, Elämänaukio 1, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Otso Arponen
- Department of Radiology, Tampere University Hospital, Elämänaukio 1, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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20
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Obermann M, Nohava L, Frass-Kriegl R, Soanca O, Ginefri JC, Felblinger J, Clauser P, Baltzer PA, Laistler E. Panoramic Magnetic Resonance Imaging of the Breast With a Wearable Coil Vest. Invest Radiol 2023; 58:799-810. [PMID: 37227137 PMCID: PMC10581436 DOI: 10.1097/rli.0000000000000991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Breast cancer, the most common malignant cancer in women worldwide, is typically diagnosed by x-ray mammography, which is an unpleasant procedure, has low sensitivity in women with dense breasts, and involves ionizing radiation. Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality and works without ionizing radiation, but is currently constrained to the prone imaging position due to suboptimal hardware, therefore hampering the clinical workflow. OBJECTIVES The aim of this work is to improve image quality in breast MRI, to simplify the clinical workflow, shorten measurement time, and achieve consistency in breast shape with other procedures such as ultrasound, surgery, and radiation therapy. MATERIALS AND METHODS To this end, we propose "panoramic breast MRI"-an approach combining a wearable radiofrequency coil for 3 T breast MRI (the "BraCoil"), acquisition in the supine position, and a panoramic visualization of the images. We demonstrate the potential of panoramic breast MRI in a pilot study on 12 healthy volunteers and 1 patient, and compare it to the state of the art. RESULTS With the BraCoil, we demonstrate up to 3-fold signal-to-noise ratio compared with clinical standard coils and acceleration factors up to 6 × 4. Panoramic visualization of supine breast images reduces the number of slices to be viewed by a factor of 2-4. CONCLUSIONS Panoramic breast MRI allows for high-quality diagnostic imaging and facilitated correlation to other diagnostic and interventional procedures. The developed wearable radiofrequency coil in combination with dedicated image processing has the potential to improve patient comfort while enabling more time-efficient breast MRI compared with clinical coils.
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21
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Allen TJ, Henze Bancroft LC, Unal O, Estkowski LD, Cashen TA, Korosec F, Strigel RM, Kelcz F, Fowler AM, Gegios A, Thai J, Lebel RM, Holmes JH. Evaluation of a Deep Learning Reconstruction for High-Quality T2-Weighted Breast Magnetic Resonance Imaging. Tomography 2023; 9:1949-1964. [PMID: 37888744 PMCID: PMC10611328 DOI: 10.3390/tomography9050152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Deep learning (DL) reconstruction techniques to improve MR image quality are becoming commercially available with the hope that they will be applicable to multiple imaging application sites and acquisition protocols. However, before clinical implementation, these methods must be validated for specific use cases. In this work, the quality of standard-of-care (SOC) T2w and a high-spatial-resolution (HR) imaging of the breast were assessed both with and without prototype DL reconstruction. Studies were performed using data collected from phantoms, 20 retrospectively collected SOC patient exams, and 56 prospectively acquired SOC and HR patient exams. Image quality was quantitatively assessed via signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness. Qualitatively, all in vivo images were scored by either two or four radiologist readers using 5-point Likert scales in the following categories: artifacts, perceived sharpness, perceived SNR, and overall quality. Differences in reader scores were tested for significance. Reader preference and perception of signal intensity changes were also assessed. Application of the DL resulted in higher average SNR (1.2-2.8 times), CNR (1.0-1.8 times), and image sharpness (1.2-1.7 times). Qualitatively, the SOC acquisition with DL resulted in significantly improved image quality scores in all categories compared to non-DL images. HR acquisition with DL significantly increased SNR, sharpness, and overall quality compared to both the non-DL SOC and the non-DL HR images. The acquisition time for the HR data only required a 20% increase compared to the SOC acquisition and readers typically preferred DL images over non-DL counterparts. Overall, the DL reconstruction demonstrated improved T2w image quality in clinical breast MRI.
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Affiliation(s)
- Timothy J. Allen
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Leah C. Henze Bancroft
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Orhan Unal
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | | | - Ty A. Cashen
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA (R.M.L.)
| | - Frank Korosec
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Roberta M. Strigel
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
- Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Frederick Kelcz
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Amy M. Fowler
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
- Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Alison Gegios
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Janice Thai
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - R. Marc Lebel
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188, USA (R.M.L.)
| | - James H. Holmes
- Department of Radiology, University of Iowa, 169 Newton Road, Iowa City, IA 52242, USA
- Department of Biomedical Engineering, University of Iowa, 3100 Seamans Center, Iowa City, IA 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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22
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Björnström M, Niinikoski L, Arlan K, Meretoja TJ, Ståhls A, Hukkinen K. Vacuum-assisted excision of small breast cancers under ultrasound guidance. Eur J Radiol 2023; 167:111049. [PMID: 37611442 DOI: 10.1016/j.ejrad.2023.111049] [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: 04/25/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The purpose of this study was to evaluate if it is possible to completely remove small breast cancer tumours with vacuum-assisted excision (VAE) under ultrasound guidance. METHODS Women ≥ 50 years old with a biopsy proven invasive cancer ≤ 10 mm were selected between October 2021 and November 2021 based on referrals and enrolled in this prospective study. The patients underwent VAE within six weeks following biopsy to remove the tumour. After the tumour was excised and the biopsy cavities margins were shaved, a radioactive seed was inserted into the biopsy cavity. The VAE excision cavity and surrounding tissue were surgically excised. Preliminary VAE results were evaluated after ten patients. For the study to proceed at least 80 % of the breast cancer tumours had to be completely removed by VAE. RESULTS The tumours median size in mammography was 8.5 mm (6-9 mm) and in ultrasound 6.5 mm (4-9 mm). The shape of the lesion was round in three (30 %), oval in two (20 %) and irregular in five (50 %) patients. None of the tumours were completely removed in the first VAE specimen, meaning that there was invasive cancer or ductal carcinoma in situ (DCIS) in the "shaved margins" and/or the surgical specimen. In five (50 %) cases, the surgical specimen was free of invasive cancer and DCIS. CONCLUSIONS None of the small invasive breast cancers were completely excised with VAE under ultrasound guidance, therefore it is not a reliable method to remove small breast cancers.
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Affiliation(s)
- Michaela Björnström
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Laura Niinikoski
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Kirill Arlan
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Tuomo J Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Anders Ståhls
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
| | - Katja Hukkinen
- HUH Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O Box 263, 00029 HUS, Finland.
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23
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Ayala de la Peña F, Antolín Novoa S, Gavilá Gregori J, González Cortijo L, Henao Carrasco F, Martínez Martínez MT, Morales Estévez C, Stradella A, Vidal Losada MJ, Ciruelos E. SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022). Clin Transl Oncol 2023; 25:2647-2664. [PMID: 37326826 PMCID: PMC10425528 DOI: 10.1007/s12094-023-03215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. Thanks to the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages, despite the COVID-19 pandemic possibly having impacted these numbers (not yet quantified). In recent years, locoregional and systemic therapies are increasingly being directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody-drug conjugates have also improved outcomes in some patient subgroups. This clinical practice guideline is based on a systematic review of relevant studies and on the consensus of experts from GEICAM, SOLTI, and SEOM.
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Affiliation(s)
- Francisco Ayala de la Peña
- Department of Medical Oncology, Hospital G. Universitario Morales Meseguer, University of Murcia, Av. Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Silvia Antolín Novoa
- Department of Medical Oncology, Complexo Hospitalario Universitario, A Coruña (CHUAC), Coruña, Spain
| | | | | | | | - María Teresa Martínez Martínez
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico of Valencia, University of Valencia, 46010, Valencia, Spain
| | | | - Agostina Stradella
- Medical Oncology Department, Institut Català d'Oncologia. L'Hospitalet,, Barcelona, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain and HM Hospitales, Madrid, Spain
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24
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. Eur Radiol 2023; 33:6213-6225. [PMID: 37138190 PMCID: PMC10415233 DOI: 10.1007/s00330-023-09600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- BioMaps (UMR1281), INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.r.l, La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy
- CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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25
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Bickel H, Clauser P, Pinker K, Helbich T, Biondic I, Brkljacic B, Dietzel M, Ivanac G, Krug B, Moschetta M, Neuhaus V, Preidler K, Baltzer P. Introduction of a breast apparent diffusion coefficient category system (ADC-B) derived from a large multicenter MRI database. Eur Radiol 2023; 33:5400-5410. [PMID: 37166495 PMCID: PMC10326122 DOI: 10.1007/s00330-023-09675-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To develop an intuitive and generally applicable system for the reporting, assessment, and documentation of ADC to complement standard BI-RADS criteria. METHODS This was a multicentric, retrospective analysis of 11 independently conducted institutional review board-approved studies from seven institutions performed between 2007 and 2019. Breast Apparent Diffusion coefficient (ADC-B) categories comprised ADC-B0 (ADC non-diagnostic), ADC-B1 (no enhancing lesion), and ADC-B2-5. The latter was defined by plotting ADC versus cumulative malignancy rates. Statistics comprised ANOVA with post hoc testing and ROC analysis. p values ≤ 0.05 were considered statistically significant. RESULTS A total of 1625 patients (age: 55.9 years (± 13.8)) with 1736 pathologically verified breast lesions were included. The mean ADC (× 10-3 mm2/s) differed significantly between benign (1.45, SD .40) and malignant lesions (.95, SD .39), and between invasive (.92, SD .22) and in situ carcinomas (1.18, SD .30) (p < .001). The following ADC-B categories were identified: ADC-B0-ADC cannot be assessed; ADC-B1-no contrast-enhancing lesion; ADC-B2-ADC ≥ 1.9 (cumulative malignancy rate < 0.1%); ADC-B3-ADC 1.5 to < 1.9 (0.1-1.7%); ADC-B4-ADC 1.0 to < 1.5 (10-24.5%); and ADC-B5-ADC < 1.0 (> 24.5%). At the latter threshold, a positive predictive value of 95.8% (95% CI 0.94-0.97) for invasive versus non-invasive breast carcinomas was reached. CONCLUSIONS The breast apparent diffusion coefficient system (ADC-B) provides a simple and widely applicable categorization scheme for assessment, documentation, and reporting of apparent diffusion coefficient values in contrast-enhancing breast lesions on MRI. CLINICAL RELEVANCE STATEMENT The ADC-B system, based on diverse MRI examinations, is clinically relevant for stratifying breast cancer risk via apparent diffusion coefficient measurements, and complements BI-RADS for improved clinical decision-making and patient outcomes. KEY POINTS • The breast apparent diffusion coefficient category system (ADC-B) is a simple tool for the assessment, documentation, and reporting of ADC values in contrast-enhancing breast lesions on MRI. • The categories comprise ADC-B0 for non-diagnostic examinations, ADC-B1 for examinations without an enhancing lesion, and ADC-B2-5 for enhancing lesions with an increasing malignancy rate. • The breast apparent diffusion coefficient category system may be used to complement BI-RADS in clinical decision-making.
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Affiliation(s)
- Hubert Bickel
- Dpt. of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Diagnosezentrum Meidling, Meidlinger Hauptstr. 7 - 9, 1120, Vienna, Austria
| | - Paola Clauser
- Dpt. of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katja Pinker
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Thomas Helbich
- Dpt. of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Iva Biondic
- Dpt. of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Avenija Gojka Šuška 6, 10 000, Zagreb, Croatia
| | - Boris Brkljacic
- Dpt. of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Avenija Gojka Šuška 6, 10 000, Zagreb, Croatia
| | - Matthias Dietzel
- Dpt. of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Gordana Ivanac
- Dpt. of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Avenija Gojka Šuška 6, 10 000, Zagreb, Croatia
| | - Barbara Krug
- Dpt. of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Marco Moschetta
- Dpt. of Emergency and Organ Transplantation-Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Victor Neuhaus
- Dpt. of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Klaus Preidler
- Diagnosezentrum Meidling, Meidlinger Hauptstr. 7 - 9, 1120, Vienna, Austria
| | - Pascal Baltzer
- Dpt. of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Lobbes MBI, Neeter LMFH, Raat F, Turk K, Wildberger JE, van Nijnatten TJA, Nelemans PJ. The performance of contrast-enhanced mammography and breast MRI in local preoperative staging of invasive lobular breast cancer. Eur J Radiol 2023; 164:110881. [PMID: 37201248 DOI: 10.1016/j.ejrad.2023.110881] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Breast MRI is considered the best modality for preoperative staging of invasive lobular carcinoma (ILC). However, contrast-enhanced mammography (CEM) shows comparable diagnostic performance to MRI, but evidence of CEM's accuracy in women diagnosed with ILC is scant. We aimed to retrospectively evaluate CEM and MRI accuracy in preoperative staging of ILC. METHODS ILC cases diagnosed between 2013 and 2021 were collected. For both modalities, tumour diameter was extracted from the reports. Bland-Altman plots were used to assess discrepancies between size measurements according to imaging and histopathological findings. CEM and MRI's ability to detect multifocal/contralateral cancer was expressed as sensitivity, specificity, and diagnostic odds ratios (DORs). Pairwise comparison of women undergoing both CEM and MRI was not performed. RESULTS 305 ILC-cases fulfilled preset inclusion criteria. Mean age was 63.7 years. Preoperative staging was performed using MRI or CEM in 266 (87.2%) and 77 (25.2%) cases, respectively. MRI and CEM overestimated tumour size by 1.5 and 2.1 mm, respectively. Sensitivity to detect multifocal disease was higher for MRI than for CEM (86% versus 78%), but specificity was lower for MRI (79% versus 92%). For detection of contralateral breast cancer, sensitivity for MRI was 96% versus 88% for CEM, and specificity was 92% and 99%, respectively. For both indications, DOR was higher for CEM, but differences were non-significant (p = 0.56 and p = 0.78). CONCLUSION CEM and MRI overestimate ILC size with comparable systematic and random errors. MRI's higher sensitivity for detection of multifocal/contralateral cancers is accompanied by lower specificity, but discriminative ability for both modalities was non-significant.
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Affiliation(s)
- Marc B I Lobbes
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Lidewij M F H Neeter
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Frank Raat
- Laurentius Hospital, Department of Radiology, P.O. Box 920, 6040AX Roermond, the Netherlands.
| | - Kim Turk
- Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands.
| | - Joachim E Wildberger
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Thiemo J A van Nijnatten
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Patricia J Nelemans
- Maastricht University, Department of Epidemiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
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Deidda S, Spolverato G, Capelli G, Bao RQ, Bettoni L, Crimì F, Zorcolo L, Pucciarelli S, Restivo A. Limits of Clinical Restaging in Detecting Responders After Neoadjuvant Therapies for Rectal Cancer. Dis Colon Rectum 2023; 66:957-964. [PMID: 36538694 DOI: 10.1097/dcr.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accurate clinical restaging is required to select patients who respond to neoadjuvant chemoradiotherapy for locally advanced rectal cancer and who may benefit from an organ preservation strategy. OBJECTIVE The purpose of this study was to review our experience with the clinical restaging of rectal cancer after neoadjuvant therapy to assess its accuracy in detecting major and pathological complete response to treatment. DESIGN This was a retrospective cohort study. SETTING This study was conducted at 2 high-volume Italian centers for Colorectal Surgery. PATIENTS Data were included from all consecutive patients who underwent neoadjuvant therapy and surgery for locally advanced rectal cancer from January 2012 to July 2020. Criteria to define clinical response were no palpable mass, a superficial ulcer <2 cm (major response), or no mucosal abnormality (complete response) at endoscopy and no metastatic nodes at MRI. MAIN OUTCOME MEASURES The main outcome measures were sensitivity, specificity, positive predictive values, and negative predictive values of clinical restaging in detecting pathological complete response (ypT0) or major pathological response (ypT0-1) after neoadjuvant therapy. RESULTS A total of 333 patients were included; 81 (24.3%) had a complete response whereas 115 (34.5%) had a pathological major response. Accuracy for clinical complete response was 80.8% and for major clinical response was 72.9%. Sensitivity was low for both clinical complete response (37.5%) in detecting ypT0 and clinical major response (59.3%) in detecting ypT0-1. Positive predictive value was 68.2% for ypT0 and 60.4% for ypT0-1. LIMITATIONS The main limitation of the study its retrospective nature. CONCLUSION Accuracy of actual clinical criteria to define pathological complete response or pathological major response is poor. Failure to achieve good sensitivity and precision is a major limiting factor in the clinical setting. Current clinical assessments need to be revised to account for indications for rectal preservation after neoadjuvant chemoradiotherapy. See Video Abstract at http://links.lww.com/DCR/C63 . LMITES DE LA REESTADIFICACIN CLNICA EN LA DETECCIN DE RESPONDEDORES DESPUS DE TERAPIAS NEOADYUVANTES PARA EL CNCER DE RECTO ANTECEDENTES:Se requiere una nueva reestadificación clínica precisa para seleccionar pacientes que respondan a la quimiorradioterapia neoadyuvante para el cáncer de recto localmente avanzado y que puedan beneficiarse de una estrategia de preservación de órganos.OBJETIVO:El propósito de este estudio fue revisar nuestra experiencia con la reestadificación clínica del cáncer de recto después de la terapia neoadyuvante para evaluar su precisión en la detección de una respuesta patológica importante y completa al tratamiento.DISEÑO:Estudio de cohorte retrospectivo.AJUSTE:Este estudio se realizó en dos centros italianos de alto volumen para cirugía colorrectal.PACIENTES:Incluimos datos de todos los pacientes consecutivos que se sometieron a terapia neoadyuvante y cirugía por cáncer de recto localmente avanzado desde enero de 2012 hasta julio de 2020. Los criterios para definir la respuesta clínica fueron ausencia de masa palpable, úlcera superficial <2 cm (respuesta mayor) o ausencia de anomalías en la mucosa. (respuesta completa) en la endoscopia, y sin ganglios metastásicos en la resonancia magnética.PRINCIPALES MEDIDAS DE RESULTADO:Exploramos la sensibilidad, la especificidad, los valores predictivos positivos y negativos de la reestadificación clínica para detectar una respuesta patológica completa (ypT0) o mayor (ypT0-1) después de la terapia neoadyuvante.RESULTADOS:Se incluyeron 333 pacientes; 81 (24,3%) tuvieron una respuesta completa mientras que 115 (34,5%) tuvieron una respuesta patológica mayor. La precisión de la respuesta clínica completa y la respuesta clínica importante fue del 80,8 % y el 72,9 %, respectivamente. La sensibilidad fue baja tanto para la respuesta clínica completa (37,5 %) en la detección de ypT0 como para la respuesta clínica mayor (59,3 %) en la detección de ypT0-1. El valor predictivo positivo fue del 68,2 % para ypT0 y del 60,4 % para ypT0-1.LIMITACIONES:Nuestro estudio tiene como principal limitación su carácter retrospectivo.CONCLUSIÓNES:La precisión de los criterios clínicos reales para definir una respuesta patológica completa o mayor es pobre. El hecho de no lograr una buena sensibilidad y precisión es un factor limitante importante en el entorno clínico. La indicación para la preservación rectal después de la quimiorradioterapia neoadyuvante necesita una mejora de la evaluación clínica actual. Consulte Video Resumen en http://links.lww.com/DCR/C63 . (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Simona Deidda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Giulia Capelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Riccardo Quoc Bao
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Lorenzo Bettoni
- Department of Medicine (DIMED), Institute of Radiology, University of Padova, Padua, Italy
| | - Filippo Crimì
- Department of Medicine (DIMED), Institute of Radiology, University of Padova, Padua, Italy
| | - Luigi Zorcolo
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Angelo Restivo
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
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Schiaffino S, Cozzi A, Pompei B, Scarano AL, Catanese C, Catic A, Rossi L, Del Grande F, Harder Y. MRI-Conditional Breast Tissue Expander: First In-Human Multi-Case Assessment of MRI-Related Complications and Image Quality. J Clin Med 2023; 12:4410. [PMID: 37445444 DOI: 10.3390/jcm12134410] [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: 03/18/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This study aims to assess potential complications and effects on the magnetic resonance imaging (MRI) image quality of a new MRI-conditional breast tissue expander (Motiva Flora®) in its first in-human multi-case application. Twenty-four patients with 36 expanders underwent non-contrast breast MRI with T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI) sequences on a 3 T unit before breast tissue expander exchange surgery, being monitored during and after MRI for potential complications. Three board-certified breast radiologists blindly and independently reviewed image quality using a four-level scale ("poor", "sufficient", "good", and "excellent"), with inter-reader reliability being assessed with Kendall's τb. The maximum diameters of RFID-related artifacts on T1-weighted and DWI sequences were compared with the Wilcoxon signed-rank test. All 24 examinations were completed without patient-related or device-related complications. The T1-weighted and T2-weighted sequences of all the examinations had "excellent" image quality and a median 11 mm (IQR 9-12 mm) RFID artifact maximum diameter, significantly lower (p < 0.001) than on the DWI images (median 32.5 mm, IQR 28.5-34.5 mm). DWI quality was rated at least "good" in 63% of the examinations, with strong inter-reader reliability (Kendall's τb 0.837, 95% CI 0.687-0.952). This first in-human study confirms the MRI-conditional profile of this new expander, which does not affect the image quality of T1-weighted and T2-weighted sequences and moderately affects DWI quality.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Barbara Pompei
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Angela Lia Scarano
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Carola Catanese
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Armin Catic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Lorenzo Rossi
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Breast Unit of Southern Switzerland (CSSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
| | - Filippo Del Grande
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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Muradali D, Fletcher GG, Cordeiro E, Fienberg S, George R, Kulkarni S, Seely JM, Shaheen R, Eisen A. Preoperative Breast Magnetic Resonance Imaging: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline. Curr Oncol 2023; 30:6255-6270. [PMID: 37504323 PMCID: PMC10378361 DOI: 10.3390/curroncol30070463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The use of preoperative breast magnetic resonance imaging (MRI) after the diagnosis of breast cancer by mammography and/or ultrasound is inconsistent. METHODS After conducting a systematic review and meta-analysis comparing preoperative breast MRI versus no MRI, we reconvened to prepare a clinical practice guideline on this topic. RESULTS Based on the evidence that MRI improved recurrence, decreased the rates of reoperations (re-excisions or conversion mastectomy), and increased detection of synchronous contralateral breast cancer, we recommend that preoperative breast MRI should be considered on a case-by-case basis in patients diagnosed with breast cancer for whom additional information about disease extent could influence treatment. Based on stronger evidence, preoperative breast MRI is recommended in patients diagnosed with invasive lobular carcinoma for whom additional information about disease extent could influence treatment. For both recommendations, the decision to proceed with MRI would be conditional on shared decision-making between care providers and the patient, taking into account the benefits and risks of MRI as well as patient preferences. Based on the opinion of the Working Group, preoperative breast MRI is also recommended in the following more specific situations: (a) to aid in surgical planning of breast conserving surgery in patients with suspected or known multicentric or multifocal disease; (b) to identify additional lesions in patients with dense breasts; (c) to determine the presence of pectoralis major muscle/chest wall invasion in patients with posteriorly located tumours or when invasion of the pectoralis major muscle or chest wall is suspected; (d) to aid in surgical planning for skin/nipple-sparing mastectomies, autologous reconstruction, oncoplastic surgery, and breast conserving surgery with suspected nipple/areolar involvement; and (e) in patients with familial/hereditary breast cancer but who have not had recent breast MRI as part of screening or diagnosis.
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Affiliation(s)
- Derek Muradali
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Glenn G Fletcher
- Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Ralph George
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Supriya Kulkarni
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Jean M Seely
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Rola Shaheen
- Department of Radiology, Queen's University, Kingston, ON K7L 3N6, Canada
- Diagnostic Imaging, Peterborough Regional Health Centre, Peterborough, ON K9J 7C6, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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30
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Rotili A, Pesapane F, Signorelli G, Penco S, Nicosia L, Bozzini A, Meneghetti L, Zanzottera C, Mannucci S, Bonanni B, Cassano E. An Unenhanced Breast MRI Protocol Based on Diffusion-Weighted Imaging: A Retrospective Single-Center Study on High-Risk Population for Breast Cancer. Diagnostics (Basel) 2023; 13:1996. [PMID: 37370892 DOI: 10.3390/diagnostics13121996] [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: 03/01/2023] [Revised: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study aimed to investigate the use of contrast-free magnetic resonance imaging (MRI) as an innovative screening method for detecting breast cancer in high-risk asymptomatic women. Specifically, the researchers evaluated the diagnostic performance of diffusion-weighted imaging (DWI) in this population. METHODS MR images from asymptomatic women, carriers of a germline mutation in either the BRCA1 or BRCA2 gene, collected in a single center from January 2019 to December 2021 were retrospectively evaluated. A radiologist with experience in breast imaging (R1) and a radiology resident (R2) independently evaluated DWI/ADC maps and, in case of doubts, T2-WI. The standard of reference was the pathological diagnosis through biopsy or surgery, or ≥1 year of clinical and radiological follow-up. Diagnostic performances were calculated for both readers with a 95% confidence interval (CI). The agreement was assessed using Cohen's kappa (κ) statistics. RESULTS Out of 313 women, 145 women were included (49.5 ± 12 years), totaling 344 breast MRIs with DWI/ADC maps. The per-exam cancer prevalence was 11/344 (3.2%). The sensitivity was 8/11 (73%; 95% CI: 46-99%) for R1 and 7/11 (64%; 95% CI: 35-92%) for R2. The specificity was 301/333 (90%; 95% CI: 87-94%) for both readers. The diagnostic accuracy was 90% for both readers. R1 recalled 40/344 exams (11.6%) and R2 recalled 39/344 exams (11.3%). Inter-reader reproducibility between readers was in moderate agreement (κ = 0.43). CONCLUSIONS In female carriers of a BRCA1/2 mutation, breast DWI supplemented with T2-WI allowed breast cancer detection with high sensitivity and specificity by a radiologist with extensive experience in breast imaging, which is comparable to other screening tests. The findings suggest that DWI and T2-WI have the potential to serve as a stand-alone method for unenhanced breast MRI screening in a selected population, opening up new perspectives for prospective trials.
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Affiliation(s)
- Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Signorelli
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Anna Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Cristina Zanzottera
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Sara Mannucci
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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Lang M, Liang P, Shen H, Li H, Yang N, Chen B, Chen Y, Ding H, Yang W, Ji X, Zhou P, Cui L, Wang J, Xu W, Ye X, Liu Z, Yang Y, Wei T, Wang H, Yan Y, Wu C, Wu Y, Shi J, Wang Y, Fang X, Li R, Yu J. Head-to-head comparison of perfluorobutane contrast-enhanced US and multiparametric MRI for breast cancer: a prospective, multicenter study. Breast Cancer Res 2023; 25:61. [PMID: 37254149 DOI: 10.1186/s13058-023-01650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MP-MRI) has high sensitivity for diagnosing breast cancers but cannot always be used as a routine diagnostic tool. The present study aimed to evaluate whether the diagnostic performance of perfluorobutane (PFB) contrast-enhanced ultrasound (CEUS) is similar to that of MP-MRI in breast cancer and whether combining the two methods would enhance diagnostic efficiency. PATIENTS AND METHODS This was a head-to-head, prospective, multicenter study. Patients with breast lesions diagnosed by US as Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4, and 5 underwent both PFB-CEUS and MP-MRI scans. On-site operators and three reviewers categorized the BI-RADS of all lesions on two images. Logistic-bootstrap 1000-sample analysis and cross-validation were used to construct PFB-CEUS, MP-MRI, and hybrid (PFB-CEUS + MP-MRI) models to distinguish breast lesions. RESULTS In total, 179 women with 186 breast lesions were evaluated from 17 centers in China. The area under the receiver operating characteristic curve (AUC) for the PFB-CEUS model to diagnose breast cancer (0.89; 95% confidence interval [CI] 0.74, 0.97) was similar to that of the MP-MRI model (0.89; 95% CI 0.73, 0.97) (P = 0.85). The AUC of the hybrid model (0.92, 95% CI 0.77, 0.98) did not show a statistical advantage over the PFB-CEUS and MP-MRI models (P = 0.29 and 0.40, respectively). However, 90.3% false-positive and 66.7% false-negative results of PFB-CEUS radiologists and 90.5% false-positive and 42.8% false-negative results of MP-MRI radiologists could be corrected by the hybrid model. Three dynamic nomograms of PFB-CEUS, MP-MRI and hybrid models to diagnose breast cancer are freely available online. CONCLUSIONS PFB-CEUS can be used in the differential diagnosis of breast cancer with comparable performance to MP-MRI and with less time consumption. Using PFB-CEUS and MP-MRI as joint diagnostics could further strengthen the diagnostic ability. Trial registration Clinicaltrials.gov; NCT04657328. Registered 26 September 2020. IRB number 2020-300 was approved in Chinese PLA General Hospital. Every patient signed a written informed consent form in each center.
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Affiliation(s)
- Manlin Lang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100039, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Huiming Shen
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Hang Li
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, 351100, China
| | - Ning Yang
- Department of Ultrasound, Xingcheng People's Hospital, Xingcheng, 125100, China
| | - Bo Chen
- Department of Ultrasound Medicine, Lu'an People's Hospital of Anhui Province, Liuan, 237000, China
| | - Yixu Chen
- Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, 611130, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Shanghai, 200040, China
| | - Weiping Yang
- Department of Ultrasound, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Xiaohui Ji
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital, Changsha, 410000, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Jiandong Wang
- General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wentong Xu
- General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiuqin Ye
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Zhixing Liu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yu Yang
- Department of Ultrasound, Beijing Friendship Hospital, Beijing, 100050, China
| | - Tianci Wei
- Department of Ultrasound, The 2nd Affiliated Hospital of Harbin, Harbin, 150001, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Yuanyuan Yan
- Department of Ultrasound, Zhengzhou Central Hospital, Zhengzhou, 450000, China
| | - Changjun Wu
- Department of Ultrasonography, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yiyun Wu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Jingwen Shi
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yaxi Wang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Xiuxia Fang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Ran Li
- Department of Ultrasound, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, China
| | - Jie Yu
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
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Clauser P, Rasul S, Kapetas P, Fueger BJ, Milos RI, Balber T, Berroterán-Infante N, Hacker M, Helbich TH, Baltzer PAT. Prospective validation of 18F-Fluoroethylcholine as a tracer in PET/MRI for the evaluation of breast lesions and prediction of lymph node status. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01633-6. [PMID: 37221356 DOI: 10.1007/s11547-023-01633-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/19/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To assess 18F-Fluoroethylcholine (18F-FEC) as a PET/MRI tracer in the evaluation of breast lesions, breast cancer aggressiveness, and prediction of lymph node status. MATERIALS AND METHODS This prospective, monocentric study was approved by the ethics committee and patients gave written, informed consent. This clinical trial was registered in the EudraCT database (Number 2017-003089-29). Women who presented with suspicious breast lesions were included. Histopathology was used as reference standard. Simultaneous 18F-FEC PET/MRI of the breast was performed in a prone position with a dedicated breast coil. MRI was performed using a standard protocol before and after contrast agent administration. A simultaneous read by nuclear medicine physicians and radiologists collected the imaging data of MRI-detected lesions, including the maximum standardized 18F-FEC-uptake value of breast lesions (SUVmaxT) and axillary lymph nodes (SUVmaxLN). Differences in SUVmax were evaluated with the Mann-Whitney U test. To calculate diagnostic performance, the area under the receiver operating characteristics curve (ROC) was used. RESULTS There were 101 patients (mean age 52.3 years, standard deviation 12.0) with 117 breast lesions included (30 benign, 7 ductal carcinomas in situ, 80 invasive carcinomas). 18F-FEC was well tolerated by all patients. The ROC to distinguish benign from malignant breast lesions was 0.846. SUVmaxT was higher if lesions were malignant (p < 0.001), had a higher proliferation rate (p = 0.011), and were HER2-positive (p = 0.041). SUVmaxLN was higher in metastatic lymph nodes, with an ROC of 0.761 for SUVmaxT and of 0.793 for SUVmaxLN. CONCLUSION: Simultaneous 18F-FEC PET/MRI is safe and has the potential to be used for the evaluation of breast cancer aggressiveness, and prediction of lymph node status.
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Affiliation(s)
- Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Theresa Balber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Neydher Berroterán-Infante
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Hans Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | - Pascal Andreas Thomas Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Gilardi L, Airò Farulla LS, Curigliano G, Corso G, Leonardi MC, Ceci F. FDG and Non-FDG Radiopharmaceuticals for PET Imaging in Invasive Lobular Breast Carcinoma. Biomedicines 2023; 11:biomedicines11051350. [PMID: 37239021 DOI: 10.3390/biomedicines11051350] [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: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most frequent histological type of breast cancer (BC) and includes a heterogeneous spectrum of diseases with unique characteristics, especially the infiltrative growth pattern and metastatic spread. [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is extensively used in oncology and BC patient evaluation. Its role in ILCs is considered suboptimal due to its low FDG avidity. Therefore, ILCs could benefit from molecular imaging with non-FDG tracers that target other specific pathways, contributing to precision medicine. This narrative review aims to summarize the current literature on the use of FDG-PET/CT in ILC and to discuss future opportunities given by the development of innovative non-FDG radiotracers.
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Affiliation(s)
- Laura Gilardi
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lighea Simona Airò Farulla
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of New Drugs and Early Drug Development, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Daniaux M, Gruber L, De Zordo T, Geiger-Gritsch S, Amort B, Santner W, Egle D, Baltzer PAT. Preoperative staging by multimodal imaging in newly diagnosed breast cancer: Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography, ultrasound, and MRI. Eur J Radiol 2023; 163:110838. [PMID: 37080064 DOI: 10.1016/j.ejrad.2023.110838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To compare contrast-enhanced spectral mammography (CESM) with mammography (Mx), ultrasound (US), and magnetic resonance imaging (MRI) regarding breast cancer detection rate and preoperative local staging. MATERIAL AND METHODS This prospective observational, single-centre study included 128 female patients (mean age 55.8 ± 11.5 years) with a newly diagnosed malignant breast tumour during routine US and Mx were prospectively enrolled. CESM and MRI examinations were performed within the study. Analysis included interreader agreement, tumour type and grade distribution, detection rates (DR), imaging morphology, contrast-enhancement and was performed by two independent readers blinded to patient history and histopathological diagnosis. Assessment of local disease extent was compared between modalities via Bland-Altman plots. RESULTS One-hundred-and-ten tumours were classified as NST (85.9%), 4 as ILC (3.1%) and 10 as DCIS (7.8%). DR was highest for MRI (128/128, 100.0%), followed by US (124/128, 96.9%) and CESM (123/128, 96.1%) and lowest for conventional Mx (106/128, 82.8%) (p = 0.0002). Higher breast density did not negatively affect DR of US, CESM or MRI. Local tumour extent measurements based on CESM (Bland-Altman bias 6.6, standard deviation 30.2) showed comparable estimation results to MRI, surpassing Mx (23.4/43.7) and US (35.4/40.5). Even though detection of multifocality and multicentricity was highest for CESM and MRI (p < 0.0001), second-look rates, i.e., targeted US examinations after MRI or CESM, were significantly lower for CESM (10.2% of cases) compared to MRI (16.2%) with a significantly higher true positive rate for CESM (72.0%) vs. MRI (42.5%). CONCLUSION CESM is a viable alternative to MRI for lesion detection and local staging in newly diagnosed malignant breast cancer and provides higher specificity in regard to second-look examinations.
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Affiliation(s)
- Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Tobias De Zordo
- Department of Radiology, Brixsana Private Clinic, Julius-Durst-Straße 28, Brixen, Italy
| | - Sabine Geiger-Gritsch
- Medizinisches Projektmanagement, Tirol Kliniken GmbH, Anichstraße 35, Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Wolfram Santner
- Department of Radiology, Privatklinik Hirslanden, Rigistrasse 1, Cham, Switzerland
| | - Daniel Egle
- Department of Gynaecology and Obstetrics, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, Vienna, Austria
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Mehta R, Bu Y, Zhong Z, Dan G, Zhong PS, Zhou C, Hu W, Zhou XJ, Xu M, Wang S, Karaman MM. Characterization of breast lesions using multi-parametric diffusion MRI and machine learning. Phys Med Biol 2023; 68:085006. [PMID: 36808921 DOI: 10.1088/1361-6560/acbde0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/21/2023] [Indexed: 02/23/2023]
Abstract
Objective. To investigate quantitative imaging markers based on parameters from two diffusion-weighted imaging (DWI) models, continuous-time random-walk (CTRW) and intravoxel incoherent motion (IVIM) models, for characterizing malignant and benign breast lesions by using a machine learning algorithm.Approach. With IRB approval, 40 women with histologically confirmed breast lesions (16 benign, 24 malignant) underwent DWI with 11b-values (50 to 3000 s/mm2) at 3T. Three CTRW parameters,Dm,α, andβand three IVIM parametersDdiff,Dperf, andfwere estimated from the lesions. A histogram was generated and histogram features of skewness, variance, mean, median, interquartile range; and the value of the 10%, 25% and 75% quantiles were extracted for each parameter from the regions-of-interest. Iterative feature selection was performed using the Boruta algorithm that uses the Benjamin Hochberg False Discover Rate to first determine significant features and then to apply the Bonferroni correction to further control for false positives across multiple comparisons during the iterative procedure. Predictive performance of the significant features was evaluated using Support Vector Machine, Random Forest, Naïve Bayes, Gradient Boosted Classifier (GB), Decision Trees, AdaBoost and Gaussian Process machine learning classifiers.Main Results. The 75% quantile, and median ofDm; 75% quantile off;mean, median, and skewness ofβ;kurtosis ofDperf; and 75% quantile ofDdiffwere the most significant features. The GB differentiated malignant and benign lesions with an accuracy of 0.833, an area-under-the-curve of 0.942, and an F1 score of 0.87 providing the best statistical performance (p-value < 0.05) compared to the other classifiers.Significance. Our study has demonstrated that GB with a set of histogram features from the CTRW and IVIM model parameters can effectively differentiate malignant and benign breast lesions.
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Affiliation(s)
- Rahul Mehta
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Yangyang Bu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Zheng Zhong
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Guangyu Dan
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ping-Shou Zhong
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Changyu Zhou
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Weihong Hu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xiaohong Joe Zhou
- Departments of Radiology and Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Maosheng Xu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Shiwei Wang
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - M Muge Karaman
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
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Alikhassi A, Li X, Au F, Kulkarni S, Ghai S, Allison G, Freitas V. False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features. Breast Cancer Res Treat 2023; 198:321-334. [PMID: 36740611 DOI: 10.1007/s10549-023-06861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/08/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify demographic and imaging features of MRI-detected enhancing lesions without clinical, ultrasound, and mammographic correlation associated with false-positive outcomes, impacting patient care. MATERIALS AND METHODS A retrospective multi-institutional study of imaging studies and patient's chart review of consecutive women with MRI-detected enhancing lesions without clinical, mammogram, or ultrasound correlation between January and December 2018, who underwent MRI-guided biopsy. According to the BI-RADS lexicon, lesions' frequency and imaging features were recorded. The demographic and imaging characteristics variables were correlated with histopathology as the gold standard and an uneventful follow-up of at least one year. Univariate logistic regression analysis was used to explore the correlation between the baseline variables such as age, genetic mutation, family history of breast cancer, personal history of breast cancer, MRI indication, background parenchymal enhancement, and MRI characteristic of the lesion with the false-positive results in main data and subgroup analysis. RESULTS Two hundred nineteen women (median age 49 years; range 26-85 years) with 219 MRI-detected enhancing lesions that underwent MRI-guided vacuum-assisted biopsy during the study period fulfilled the study criteria and formed the study cohort. Out of 219, 180 lesions (82.2%) yielded benign pathology results, including 137 benign outcomes (76%) and 43 high-risk lesions (24%). Most demographic and imaging characteristics variables did not help to differentiate malignant from benign lesions. The variables that showed statistically significant association with true-positive results in univariate analyses were age (OR 1.05; 95% CI 1.02-1.08; p = 0.0015), irregular mass-lesion shape when compared with oval/round mass lesion (OR 11.2; 95% CI 1.6-78.4; p = 0.015), and clumped and clustered ring of enhancement when compared with homogeneous (OR 3.22, 95% CI 1.40-7.40; p = 0.0058). For participants with mass breast lesion, the hyperintense signal on the T2-weighted sequence (compared to the normal fibroglandular signal) was significantly related to the false-positive result (OR 0.13; 95% CI 0.02-0.76; p = 0.024). CONCLUSION Young patients, oval/round mass-lesion shape, and homogeneous pattern of non-mass enhancement showed the strongest association with false-positive results of enhancing lesions depicted by MRI. For participants with mass breast lesion, T2-bright mass lesion showed significant association with false-positive result. It may impact the patient's management with a suggestion of follow-up rather than interventional procedure when these demographic and imaging parameters are present, consequently decreasing the patient's anxiety and health care costs.
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Affiliation(s)
- Afsaneh Alikhassi
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Xuan Li
- Department of Biostatistics-Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 10Th Floor, Room 10-509, Toronto, ON, M5G 2M9, Canada
| | - Frederick Au
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Grant Allison
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Deutschmann C, Singer CF, Gschwantler-Kaulich D, Pfeiler G, Leser C, Baltzer PAT, Helbich TH, Kraus C, Korbatits R, Marzogi A, Clauser P. Residual fibroglandular breast tissue after mastectomy is associated with an increased risk of a local recurrence or a new primary breast cancer". BMC Cancer 2023; 23:281. [PMID: 36978031 PMCID: PMC10044359 DOI: 10.1186/s12885-023-10764-y] [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: 05/10/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Residual fibroglandular breast tissue (RFGT) following a mastectomy has been claimed to be associated with the occurrence of an in-breast local recurrence (IBLR) or new primary tumor (NP). Yet, scientific evidence proving this assumption is lacking. The primary aim of the study was to verify whether RFGT following a mastectomy is a risk factor for an IBLR or NP. METHODS This retrospective analysis included all patients that underwent a mastectomy and were followed up at the Department of Obstetrics and Gynecology of the Medical University of Vienna between 01.01.2015 and 26.02.2020. RFGT volume (assessed on magnetic resonance imaging) was correlated with the prevalence of an IBLR and a NP. RESULTS A total of 105 patients (126 breasts) following a therapeutic mastectomy were included. After a mean follow-up of 46.0 months an IBLR had occurred in 17 breasts and a NP in 1 breast. A significant difference in RFGT volume was observed between the disease-free cohort and the subgroup with an IBLR or NP (p = .017). A RFGT volume of ≥ 1153 mm3 increased the risk by the factor 3.57 [95%CI 1.27; 10.03]. CONCLUSIONS RFGT volume is associated with an increased risk for an IBLR or NP.
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Affiliation(s)
- Christine Deutschmann
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carmen Leser
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Kraus
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ricarda Korbatits
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alaa Marzogi
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Christensen DM, Shehata MN, Javid SH, Rahbar H, Lam DL. Preoperative Breast MRI: Current Evidence and Patient Selection. JOURNAL OF BREAST IMAGING 2023; 5:112-124. [PMID: 38416933 DOI: 10.1093/jbi/wbac088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Indexed: 03/01/2024]
Abstract
Breast MRI is the most sensitive imaging modality for the assessment of newly diagnosed breast cancer extent and can detect additional mammographically and clinically occult breast cancers in the ipsilateral and contralateral breasts. Nonetheless, appropriate use of breast MRI in the setting of newly diagnosed breast cancer remains debated. Though highly sensitive, MRI is less specific and may result in false positives and overestimation of disease when MRI findings are not biopsied prior to surgical excision. Furthermore, improved anatomic depiction of breast cancer on MRI has not consistently translated to improved clinical outcomes, such as lower rates of re-excision or breast cancer recurrence, though there is a paucity of well-designed studies examining these issues. In addition, current treatment paradigms have been developed in the absence of this more accurate depiction of disease span, which likely has limited the value of MRI. These issues have led to inconsistent and variable utilization of preoperative MRI across practice settings and providers. In this review, we discuss the history of breast MRI and its current use and recommendations with a focus on the preoperative setting. We review the evidence surrounding the use of preoperative MRI in the evaluation of breast malignancies and discuss the data on breast MRI in the setting of specific patient factors often used to determine breast MRI eligibility, such as age, index tumor phenotype, and breast density. Finally, we review the impact of breast MRI on surgical outcomes (re-excision and mastectomy rates) and long-term breast recurrence and survival outcomes.
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Affiliation(s)
- Diana M Christensen
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Mariam N Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Sara H Javid
- University of Washington School of Medicine, Department of Surgery, Seattle, WA, USA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Diana L Lam
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
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Freehand 1.5T MR-Guided Vacuum-Assisted Breast Biopsy (MR-VABB): Contribution of Radiomics to the Differentiation of Benign and Malignant Lesions. Diagnostics (Basel) 2023; 13:diagnostics13061007. [PMID: 36980315 PMCID: PMC10047866 DOI: 10.3390/diagnostics13061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Radiomics and artificial intelligence have been increasingly applied in breast MRI. However, the advantages of using radiomics to evaluate lesions amenable to MR-guided vacuum-assisted breast biopsy (MR-VABB) are unclear. This study includes patients scheduled for MR-VABB, corresponding to subjects with MRI-only visible lesions, i.e., with a negative second-look ultrasound. The first acquisition of the multiphase dynamic contrast-enhanced MRI (DCE-MRI) sequence was selected for image segmentation and radiomics analysis. A total of 80 patients with a mean age of 55.8 years ± 11.8 (SD) were included. The dataset was then split into a training set (50 patients) and a validation set (30 patients). Twenty out of the 30 patients with a positive histology for cancer were in the training set, while the remaining 10 patients with a positive histology were included in the test set. Logistic regression on the training set provided seven features with significant p values (<0.05): (1) ‘AverageIntensity’, (2) ‘Autocorrelation’, (3) ‘Contrast’, (4) ‘Compactness’, (5) ‘StandardDeviation’, (6) ‘MeanAbsoluteDeviation’ and (7) ‘InterquartileRange’. AUC values of 0.86 (95% C.I. 0.73–0.94) for the training set and 0.73 (95% C.I. 0.54–0.87) for the test set were obtained for the radiomics model. Radiological evaluation of the same lesions scheduled for MR-VABB had AUC values of 0.42 (95% C.I. 0.28–0.57) for the training set and 0.4 (0.23–0.59) for the test set. In this study, a radiomics logistic regression model applied to DCE-MRI images increased the diagnostic accuracy of standard radiological evaluation of MRI suspicious findings in women scheduled for MR-VABB. Confirming this performance in large multicentric trials would imply that using radiomics in the assessment of patients scheduled for MR-VABB has the potential to reduce the number of biopsies, in suspicious breast lesions where MR-VABB is required, with clear advantages for patients and healthcare resources.
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Schmidt MK, Kelly JE, Brédart A, Cameron DA, de Boniface J, Easton DF, Offersen BV, Poulakaki F, Rubio IT, Sardanelli F, Schmutzler R, Spanic T, Weigelt B, Rutgers EJT. EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy. Eur J Cancer 2023; 181:79-91. [PMID: 36641897 PMCID: PMC10326619 DOI: 10.1016/j.ejca.2022.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.
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Affiliation(s)
- Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Anne Brédart
- Institut Curie, Paris, France; Psychology Institute, Psychopathology and Health Process Laboratory UR4057, Paris City University, Paris, France
| | - David A Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital - Aarhus University, Aarhus N, Denmark
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - 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
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Surgical Planning after Neoadjuvant Treatment in Breast Cancer: A Multimodality Imaging-Based Approach Focused on MRI. Cancers (Basel) 2023; 15:cancers15051439. [PMID: 36900231 PMCID: PMC10001061 DOI: 10.3390/cancers15051439] [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: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) today represents a cornerstone in the treatment of locally advanced breast cancer and highly chemo-sensitive tumors at early stages, increasing the possibilities of performing more conservative treatments and improving long term outcomes. Imaging has a fundamental role in the staging and prediction of the response to NACT, thus aiding surgical planning and avoiding overtreatment. In this review, we first examine and compare the role of conventional and advanced imaging techniques in preoperative T Staging after NACT and in the evaluation of lymph node involvement. In the second part, we analyze the different surgical approaches, discussing the role of axillary surgery, as well as the possibility of non-operative management after-NACT, which has been the subject of recent trials. Finally, we focus on emerging techniques that will change the diagnostic assessment of breast cancer in the near future.
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Clinical impact of MRI-detected additional lesions in breast cancer patients with neoadjuvant systemic therapy at the Netherlands cancer institute. Breast Cancer Res Treat 2023; 198:131-141. [PMID: 36592232 DOI: 10.1007/s10549-022-06840-9] [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: 08/04/2022] [Accepted: 12/03/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND In breast cancer patients treated with neoadjuvant systemic therapy (NST), MRI is used pre- and post-NST for response monitoring. The relevance of additional MRI-detected lesions in these patients is unclear. Therefore, we aimed to assess the impact of pre-NST MRI-detected additional lesions on surgical treatment and outcome. METHODS We retrospectively selected all early-stage breast cancer patients with MRI pre-NST at our institute from January 2010-2015. MRI-detected lesions were defined as separated from the index tumor and occult at conventional mammography and ultrasound. Outcomes were change in surgical treatment and five-year recurrence-free and overall survival. RESULTS Overall, MRI detected additional lesions in 206 (31%) of 656 patients: in 160 patients in the ipsilateral breast and in 78 contralateral breasts, including 32 bilateral cases. Ipsilateral lesions were mostly categorized BI-RADS 5 (54 %) and contralateral lesions BI-RADS 3 (64%). Targeted ultrasound was performed in 115 (56%) patients: in 70 ipsilateral and in 64 contralateral cases. Biopsy was obtained in 44 (28% of 160) ipsilateral and 50 (64% of 78) contralateral breasts, containing tumor foci in 20 (13% of 160) and 11 (14% of 78) cases, respectively. Surgical treatment changed in 54 (26% of 206) patients: 19 (9%) had mastectomy, 24 (12%) had wider local excision and 11 (5%) underwent contralateral surgery. Five-year recurrence-free and overall survival did not differ for patients with local excision or mastectomy. CONCLUSION Pre-NST MRI-detected additional lesions in 31% of patients, resulting in more extensive surgery in 26% of these patients, including 5% contralateral surgeries.
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Zheng D, He X, Jing J. Overview of Artificial Intelligence in Breast Cancer Medical Imaging. J Clin Med 2023; 12:jcm12020419. [PMID: 36675348 PMCID: PMC9864608 DOI: 10.3390/jcm12020419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
The heavy global burden and mortality of breast cancer emphasize the importance of early diagnosis and treatment. Imaging detection is one of the main tools used in clinical practice for screening, diagnosis, and treatment efficacy evaluation, and can visualize changes in tumor size and texture before and after treatment. The overwhelming number of images, which lead to a heavy workload for radiologists and a sluggish reporting period, suggests the need for computer-aid detection techniques and platform. In addition, complex and changeable image features, heterogeneous quality of images, and inconsistent interpretation by different radiologists and medical institutions constitute the primary difficulties in breast cancer screening and imaging diagnosis. The advancement of imaging-based artificial intelligence (AI)-assisted tumor diagnosis is an ideal strategy for improving imaging diagnosis efficient and accuracy. By learning from image data input and constructing algorithm models, AI is able to recognize, segment, and diagnose tumor lesion automatically, showing promising application prospects. Furthermore, the rapid advancement of "omics" promotes a deeper and more comprehensive recognition of the nature of cancer. The fascinating relationship between tumor image and molecular characteristics has attracted attention to the radiomic and radiogenomics, which allow us to perform analysis and detection on the molecular level with no need for invasive operations. In this review, we integrate the current developments in AI-assisted imaging diagnosis and discuss the advances of AI-based breast cancer precise diagnosis from a clinical point of view. Although AI-assisted imaging breast cancer screening and detection is an emerging field and draws much attention, the clinical application of AI in tumor lesion recognition, segmentation, and diagnosis is still limited to research or in limited patients' cohort. Randomized clinical trials based on large and high-quality cohort are lacking. This review aims to describe the progress of the imaging-based AI application in breast cancer screening and diagnosis for clinicians.
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Muscle mass loss in breast cancer patients of reproductive age (≤ 45 years) undergoing neoadjuvant chemotherapy. LA RADIOLOGIA MEDICA 2023; 128:49-57. [PMID: 36536266 DOI: 10.1007/s11547-022-01574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Loss of muscle mass is associated with negative clinical outcome in breast cancer (BC) patients. Therefore, the aim of the study is to evaluate if there is pectoralis muscle area (PMA) depletion, reflecting loss of muscle mass, in breast cancer patients of reproductive age (≤ 45 years) undergoing neoadjuvant chemotherapy (NAC) and to correlate PMA with clinical and histopathological data. MATERIAL AND METHODS This monocentric study, approved by our institutional review board, enrolled a total of 52 consecutive patients (mean age 37 ± 4.96 years) with histologically proven primary breast cancer between January 2019 and September 2021, treated with NAC and in whom tumor response and PMA were assessed with breast MRI. Two radiologists calculated PMA before and after NAC independently and blindly on axial 3D FLASH pre-contrast T1-weighted images. Wilcoxon-Mann-Whitney U test compared median values and percentage changes of pectoralis muscle area at the beginning and at the end of NAC (158 ± 25.5 days). Multivariate regression analysis on ΔPMA (difference between PMA pre-NAC and PMA post-NAC) was done according to clinical and histopathological data. Inter-reader and intra-reader agreement was estimated with K statistics. RESULTS Pre-NAC PMA mean value was larger than post-NAC PMA mean value (9.6 ± 2.6 cm2 vs. 8.7 ± 2.2 cm2, p < 0.001, delta value 1.41). According to the RECIST criteria, no significant differences between complete and partial response were found. Multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI examinations, estrogen and progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 expression, lymph node involvement, RECIST criteria, histological type, and different regimes of NAC. Inter-reader (k = 0.74) and intra-reader agreement (0.67 and 0.73) in PMA assessment was good. CONCLUSIONS PMA variation in BC young patients, directly estimated on breast MRI, could be a potential tool to monitor body composition during NAC with potential implications in improving outcome.
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Sherminie LPG, Jayatilake ML. Fractal Dimension Analysis of Pixel Dynamic Contrast Enhanced-Magnetic Resonance Imaging Pharmacokinetic Parameters for Discrimination of Benign and Malignant Breast Lesions. JCO Clin Cancer Inform 2023; 7:e2200101. [PMID: 36745858 DOI: 10.1200/cci.22.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer in women worldwide. However, its diagnosis mostly depends on visual examination of radiologic images, leading to an overdiagnosis with substantial costs. Therefore, a quantitative approach such as dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI) through pharmacokinetic (PK) modeling is required for reliable analysis. As PK parameters lack information on parameter heterogeneity, texture-based analysis is required to quantify PK parameter heterogeneity. Therefore, this study focused on determining the usefulness of fractal dimension (FD) as a potential imaging biomarker of tumor heterogeneity for discriminating benign and malignant breast lesions. METHODS Parametric maps for PK parameters, extravasation rate of contrast agent from blood plasma to extravascular extracellular space (Ktrans) and volume fraction of extravascular extracellular space (ve), were generated for the regions of interest (ROIs) under the standard model using 18 lesions. Then, tumor ROI and pixel DCE-MRI time-course data were analyzed to extract pixel values of Ktrans and ve. For each ROI, FD values of Ktrans and ve were computed using the blanket method. RESULTS The FD values of Ktrans for benign and malignant lesions varied from 2.96 to 3.49 and from 2.37 to 3.16, respectively, whereas FD values of ve for benign and malignant lesions varied from 3.01 to 5.15 and 2.42 to 3.44, respectively. There were significant differences in FD values derived from Ktrans parametric maps (P = .0053) and ve parametric maps (P = .0271) between benign and malignant lesions according to the statistical analysis. CONCLUSION Incorporating texture heterogeneity changes in breast lesions captured by FD with quantitative DCE-MRI parameters generated under the standard model is a potential marker for prediction of malignant lesions.
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Affiliation(s)
- Lahanda Purage G Sherminie
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka.,Department of Radiography/Radiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mohan L Jayatilake
- Department of Radiography/Radiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Sabatino V, Pignata A, Valentini M, Fantò C, Leonardi I, Campora M. Assessment and Response to Neoadjuvant Treatments in Breast Cancer: Current Practice, Response Monitoring, Future Approaches and Perspectives. Cancer Treat Res 2023; 188:105-147. [PMID: 38175344 DOI: 10.1007/978-3-031-33602-7_5] [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] [Indexed: 01/05/2024]
Abstract
Neoadjuvant treatments (NAT) for breast cancer (BC) consist in the administration of chemotherapy-more rarely endocrine therapy-before surgery. Firstly, it was introduced 50 years ago to downsize locally advanced (inoperable) BCs. NAT are now widespread and so effective to be used also at the early stage of the disease. NAT are heterogeneous in terms of therapeutic patterns, class of used drugs, dosage, and duration. The poly-chemotherapy regimen and administration schedule are established by a multi-disciplinary team, according to the stage of disease, the tumor subtype and the age, the physical status, and the drug sensitivity of BC patients. Consequently, an accurate monitoring of treatment response can provide significant clinical advantages, such as the treatment de-escalation in case of early recognition of complete response or, on the contrary, the switch to an alternative treatment path in case of early detection of resistance to the ongoing therapy. Future is going toward increasingly personalized therapies and the prediction of individual response to treatment is the key to practice customized care pathways, preserving oncological safety and effectiveness. To gain such goal, the development of an accurate monitoring system, reproducible and reliable alone or as part of more complex diagnostic algorithms, will be promising.
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Affiliation(s)
- Vincenzo Sabatino
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy.
| | - Alma Pignata
- Breast Center, Spedali Civili Hospital, ASST, Brescia, Italy
| | - Marvi Valentini
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Carmen Fantò
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Irene Leonardi
- Breast Imaging Department, Santa Chiara Hospital, APSS, Trento, Italy
| | - Michela Campora
- Pathology Department, Santa Chiara Hospital, APSS, Trento, Italy
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Pires-Gonçalves L, Henriques Abreu M, Ferrão A, Guimarães Dos Santos A, Aguiar AT, Gouvêa M, Henrique R. Patient perspectives on repeated contrast-enhanced mammography and magnetic resonance during neoadjuvant chemotherapy of breast cancer. Acta Radiol 2022; 64:1816-1822. [PMID: 36575580 DOI: 10.1177/02841851221144021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden perceived by the patient of repeated imaging required for neoadjuvant chemotherapy (NAC) monitoring warrants attention due to the increased use of NAC and imaging. PURPOSE To evaluate and compare the experienced burden associated with repeated contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) during NAC for breast cancer from the patient perspective. MATERIAL AND METHODS Approval from the ethics committee and written informed consent were obtained. In this prospective study, CEM and MRI were performed on 38 patients with breast cancer before, during, and after NAC in a tertiary cancer center. The experienced burden was evaluated with a self-reported questionnaire addressing duration, comfort, anxiety, positioning, and intravenous contrast administration, each measured on a 5-point Likert scale. The participants were asked their preference between CEM or MRI. Statistical comparisons were performed and P<0.05 was considered significant. RESULTS Most participants (n = 29, 76%) preferred CEM over MRI (P = 0.0008). CEM was associated with a significantly shorter duration (P < 0.001), greater overall comfort (P < 0.01), more comfortable positioning (P = 0.01), and lower anxiety (P = 0.03). Intravenous contrast administration perception revealed no significant difference. Only 4 (10%) participants preferred MRI over CEM, due to the absence of breast compression. CONCLUSION In the hypothetical scenario of equal diagnostic accuracy, most participants preferred CEM and compared CEM favorably to MRI in all investigated features at repeated imaging required for NAC response assessment. Our results indicate that repeated examinations with CEM is well tolerated and constitutes a patient-friendly alternative for NAC imaging monitoring in breast cancer.
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Affiliation(s)
- Lígia Pires-Gonçalves
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Anabela Ferrão
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | | | - Ana Teresa Aguiar
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Margarida Gouvêa
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions. Radiol Oncol 2022; 56:461-470. [PMID: 36226804 PMCID: PMC9784367 DOI: 10.2478/raon-2022-0036] [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: 05/23/2022] [Accepted: 07/06/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The aim of the study was to compare the performance of full-field digital mammography (FFDM), digital breast tomosynthesis and a dedicated digital specimen radiography system (SRS) in consecutive patients, and to compare the margin status of resected lesions versus pathological assessment. PATIENTS AND METHODS Resected tissue specimens from consecutive patients who underwent intraoperative breast specimen assessment following wide local excision or oncoplastic breast conservative surgery were examined by FFDM, tomosynthesis and SRS. Two independent observers retrospectively evaluated the visibility of lesions, size, margins, spiculations, calcifications and diagnostic certainty, and chose the best performing method in a blinded manner. RESULTS We evaluated 216 specimens from 204 patients. All target malignant lesions were removed with no tumouron-ink. One papilloma had positive microscopic margins and one patient underwent reoperation owing to extensive in situ components. There were no significant differences in measured lesion size among the three methods. However, tomosynthesis was the most accurate modality when compared with the final pathological report. Both observers reported that tomosynthesis had significantly better lesion visibility than SRS and FFDM, which translated into a significantly greater diagnostic certainty. Tomosynthesis was superior to the other two methods in identifying spiculations and calcifications. Both observers reported that tomosynthesis was the best performing method in 76.9% of cases. The interobserver reproducibilities of lesion visibility and diagnostic certainty were high for all three methods. CONCLUSIONS Tomosynthesis was superior to SRS and FFDM for detecting and evaluating the target lesions, spiculations and calcifications, and was therefore more reliable for assessing complete excision of breast lesions.
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Fakhry S, Kamal RM, Tohamey YM, Kamal EF. Unilateral primary breast edema: Can T2-weighted images meet the diagnostic challenge? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Unilateral primary breast edema may pose a diagnostic challenge. Excluding malignant etiologies is of utmost importance and may require the use of dynamic MRI examination as a problem solver. Yet, the enhancement pattern of benign and malignant disorders associated with edematous breasts may overlap, and this may add to the dilemma. So, our aim in the current study was to assess the role of T2-weighted MR imaging as a problem-solving sequence in differentiating benign from malignant causes of the edematous breast.
Results
In the current prospective study, 65/96 cases were benign and 31/96 cases were malignant. By the individual analysis of the signal intensity in T2-weighted imaging of MRI examination, there was a significant correlation between low T2 signal intensity lesion and malignant etiology of breast edema with a resultant higher sensitivity of 83.87% and a higher specificity of 98.46% as compared to the contrast-enhanced series, which achieved a sensitivity of 80.65% and a specificity of 20.00%. The combined assessment of T2 WI and the contrast-enhanced series yielded a higher sensitivity of 100% and a specificity of 98.46%.
Conclusions
T2WI is a problem-solving sequence in the evaluation of the primary edematous breast, yielding a significant added value in the diagnostic approach and improving the overall diagnostic performance of dynamic contrast-enhanced MRI.
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Micek M, Aebisher D, Surówka J, Bartusik-Aebisher D, Madera M. Applications of T 1 and T 2 relaxation time calculation in tissue differentiation and cancer diagnostics-a systematic literature review. Front Oncol 2022; 12:1010643. [PMID: 36531030 PMCID: PMC9749890 DOI: 10.3389/fonc.2022.1010643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/31/2022] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION The purpose of this review was to summarize current applications of non-contrast-enhanced quantitative magnetic resonance imaging (qMRI) in tissue differentiation, considering healthy tissues as well as comparisons of malignant and benign samples. The analysis concentrates mainly on the epithelium and epithelial breast tissue, especially breast cancer. METHODS A systematic review has been performed based on current recommendations by publishers and foundations. An exhaustive overview of currently used techniques and their potential in medical sciences was obtained by creating a search strategy and explicit inclusion and exclusion criteria. RESULTS AND DISCUSSION PubMed and Elsevier (Scopus & Science Direct) search was narrowed down to studies reporting T1 or T2 values of human tissues, resulting in 404 initial candidates, out of which roughly 20% were found relevant and fitting the review criteria. The nervous system, especially the brain, and connective tissue such as cartilage were the most frequently analyzed, while the breast remained one of the most uncommon subjects of studies. There was little agreement between published T1 or T2 values, and methodologies and experimental setups differed strongly. Few contemporary (after 2000) resources have been identified that were dedicated to studying the relaxation times of tissues and their diagnostic applications. Most publications concentrate on recommended diagnostic standards, for example, breast acquisition of T1- or T2-weighted images using gadolinium-based contrast agents. Not enough data is available yet to decide how repeatable or reliable analysis of relaxation times is in diagnostics, so it remains mainly a research topic. So far, qMRI might be recommended as a diagnostic help providing general insight into the nature of lesions (benign vs. malignant). However, additional means are generally necessary to differentiate between specific lesion types.
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Affiliation(s)
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of The University of Rzeszow, Rzeszow, Poland
| | | | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of The University of Rzeszow, Rzeszow, Poland
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