1
|
The accuracy of magnetic resonance imaging in predicting the size of pure ductal carcinoma in situ: a systematic review and meta-analysis. NPJ Breast Cancer 2022; 8:77. [PMID: 35768442 PMCID: PMC9243148 DOI: 10.1038/s41523-022-00441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) is a putative precursor of invasive breast cancer and MRI is considered the most sensitive imaging technique for its detection. This study aims to evaluate the accuracy of MRI measuring the pure DCIS size, against pathology, to better understand the role of MRI in the management of this intraductal neoplasm.Potentially eligible studies in MEDLINE, Embase and Google Scholar, up to January 2021 were considered, and a systematic review and meta-analysis according to the published protocol (Prospero-CRD42021232228) was performed. Outcomes of mean differences and accuracy rates were analysed using IBM® SPSS® v26 and random-effect models in platform R v3.3.Twenty-two cross-sectional studies were selected and 15 proceeded to meta-analysis. MRI accurately predicted 55% of the tumours' sizes and, according to Bland-Altman plots, concordance between MRI and pathology was greater for smaller tumours. In the meta-analysis, difference of the means between MRI and pathology was 3.85 mm (CI 95% [-0.92;8.60]) with considerable heterogeneity (I2 = 96.7%). Subgroup analysis showed similar results for sizes between different MRI fields, temporal resolution, slice thickness and acquisition times, but lower heterogeneity in studies using 3-T MRI (I2 = 57.2%). Results were concordant with low risk of bias studies (2.46, CI 95% [0.57-4.36]), without heterogeneity (I2 = 0%).Therefore, MRI is shown to be an accurate method in pure DCIS size assessment. Once the best MRI protocol is established, evaluation of the impact of pure DCIS size in predicting treatment outcomes will contribute to clarifying current issues related to intraductal breast carcinoma.
Collapse
|
2
|
Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology 2021; 302:246-255. [PMID: 34931856 PMCID: PMC8805655 DOI: 10.1148/radiol.211839] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery.
Collapse
Affiliation(s)
- Lars J. Grimm
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Habib Rahbar
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Monica Abdelmalak
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Allison H. Hall
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Marc D. Ryser
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| |
Collapse
|
3
|
Bartram A, Gilbert F, Thompson A, Mann GB, Agrawal A. Breast MRI in DCIS size estimation, breast-conserving surgery and oncoplastic breast surgery. Cancer Treat Rev 2021; 94:102158. [PMID: 33610127 DOI: 10.1016/j.ctrv.2021.102158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022]
Abstract
The impact of MRI on improving surgical outcomes in DCIS is debated. Here, we explore the utility of MRI in the investigation and management of DCIS in three key areas. Firstly, we highlight that MRI is likely to be a more accurate predictor of actual tumour size than conventional imaging. Secondly, we examine mastectomy rates and reoperation rates across the literature and suggest that surgical outcomes do not differ between pre-operative MRI and conventional imaging groups, despite improved size estimation on MRI. Finally, we examine the rapidly developing field of oncoplastic breast surgery and highlight a paucity of data in determining the usefulness of pre-operative MRI in this field, despite this being an oncologically safe alternative with improved patient outcomes and satisfaction.
Collapse
Affiliation(s)
- Alexander Bartram
- University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0SP, UK
| | - Fiona Gilbert
- University of Cambridge, Department of Radiology, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Alastair Thompson
- Baylor College of Medicine, Division of Surgical Oncology, 7200 Cambridge Street, Houston, TX 77030, USA
| | - G Bruce Mann
- University of Melbourne, Department of Surgery, The Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Amit Agrawal
- Cambridge University Hospitals, Department of Breast Surgery, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
4
|
Vairavan R, Abdullah O, Retnasamy PB, Sauli Z, Shahimin MM, Retnasamy V. A Brief Review on Breast Carcinoma and Deliberation on Current Non Invasive Imaging Techniques for Detection. Curr Med Imaging 2020; 15:85-121. [PMID: 31975658 DOI: 10.2174/1573405613666170912115617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Breast carcinoma is a life threatening disease that accounts for 25.1% of all carcinoma among women worldwide. Early detection of the disease enhances the chance for survival. DISCUSSION This paper presents comprehensive report on breast carcinoma disease and its modalities available for detection and diagnosis, as it delves into the screening and detection modalities with special focus placed on the non-invasive techniques and its recent advancement work done, as well as a proposal on a novel method for the application of early breast carcinoma detection. CONCLUSION This paper aims to serve as a foundation guidance for the reader to attain bird's eye understanding on breast carcinoma disease and its current non-invasive modalities.
Collapse
Affiliation(s)
- Rajendaran Vairavan
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| | - Othman Abdullah
- Hospital Sultan Abdul Halim, 08000 Sg. Petani, Kedah, Malaysia
| | | | - Zaliman Sauli
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| | - Mukhzeer Mohamad Shahimin
- Department of Electrical and Electronic Engineering, Faculty of Engineering, National Defence University of Malaysia (UPNM), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Vithyacharan Retnasamy
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| |
Collapse
|
5
|
Khalayleh H, Khalayleh M, Diment J, Allweis TM. Breast density does not affect breast cancer tumor size assessment: A comparison of radiologic versus pathologic measurement by different imaging modalities across breast densities. Eur J Surg Oncol 2020; 46:1435-1440. [PMID: 32115332 DOI: 10.1016/j.ejso.2020.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Tumor size is an important parameter in breast cancer staging. Definitive tumor size is determined by measurement of the pathologic specimen. However, prior to surgery, size must be assessed by imaging with mammography (MMG), ultrasound (US), or magnetic resonance imaging (MRI). Discrepancies between imaging-assessed and pathologic size are not uncommon. Breast density decreases the sensitivity of MMG, and may affect image-based tumor size assessment. AIM To compare tumor size assessed by the different imaging modalities to pathologic size across breast densities. MATERIAL & METHODS This was a retrospective analysis of 183 female patients (197 breast cancers) diagnosed and operated for primary breast cancer at a single center. Tumor size measurements were collated for each available imaging modality and compared with measurements from pathologic specimens. Breast density was assessed on MMG using the Breast Imaging Reporting and Data System. RESULTS Mean pathologic tumor size was 23.0 ± 19.3 mm. Mean tumor size did not differ significantly with MMG (22.3 ± 16.6 mm; P = 0.165) or MRI (23.4 ± 19.2 mm; P = 0.620). However, US significantly underestimated mean tumor size (15.2 ± 8.6 mm; P = 0.0001 vs pathology). Breast density did not affect the accuracy of tumor size assessment by any imaging modality. CONCLUSIONS US may underestimate breast tumor size. Treatment decisions that take into account tumor size can be made equally reliably in patients with high or low breast density.
Collapse
Affiliation(s)
- Harbi Khalayleh
- Department of Surgery, Kaplan Medical Center (affiliated to the School of Medicine, Hebrew University, Jerusalem), Rehovot, Israel.
| | | | - Judith Diment
- Department of Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Tanir M Allweis
- Department of Surgery, Kaplan Medical Center (affiliated to the School of Medicine, Hebrew University, Jerusalem), Rehovot, Israel; Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
6
|
Ballantyne N, Chen YA, Rabhar H, Grimm LJ. Multimodality Imaging of Ductal Carcinoma In Situ. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-019-00349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Shehata M, Grimm L, Ballantyne N, Lourenco A, Demello LR, Kilgore MR, Rahbar H. Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment. JOURNAL OF BREAST IMAGING 2019; 1:166-176. [PMID: 31538141 DOI: 10.1093/jbi/wbz039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/27/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.
Collapse
Affiliation(s)
- Mariam Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA
| | - Lars Grimm
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Nancy Ballantyne
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Ana Lourenco
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Linda R Demello
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Mark R Kilgore
- University of Washington School of Medicine, Department of Anatomic Pathology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| |
Collapse
|
8
|
Amornsiripanitch N, Lam DL, Rahbar H. Advances in Breast MRI in the Setting of Ductal Carcinoma In Situ. Semin Roentgenol 2018; 53:261-269. [PMID: 30449344 DOI: 10.1053/j.ro.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Diana L Lam
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
| | - Habib Rahbar
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
| |
Collapse
|
9
|
Griesenauer RH, Weis JA, Arlinghaus LR, Meszoely IM, Miga MI. Toward quantitative quasistatic elastography with a gravity-induced deformation source for image-guided breast surgery. J Med Imaging (Bellingham) 2018; 5:015003. [PMID: 29430479 DOI: 10.1117/1.jmi.5.1.015003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/15/2018] [Indexed: 11/14/2022] Open
Abstract
Biomechanical breast models have been employed for applications in image registration and diagnostic analysis, breast augmentation simulation, and for surgical and biopsy guidance. Accurate applications of stress-strain relationships of tissue within the breast can improve the accuracy of biomechanical models that attempt to simulate breast deformations. Reported stiffness values for adipose, glandular, and cancerous tissue types vary greatly. Variations in reported stiffness properties have been attributed to differences in testing methodologies and assumptions, measurement errors, and natural interpatient differences in tissue elasticity. Therefore, the ability to determine patient-specific in vivo breast tissue properties would be advantageous for these procedural applications. While some in vivo elastography methods are not quantitative and others do not measure material properties under deformation conditions that are appropriate to the application of concern, in this study, we developed an elasticity estimation method that is performed using deformations representative of supine therapeutic procedures. More specifically, reconstruction of mechanical properties appropriate for the standard-of-care supine lumpectomy was performed by iteratively fitting two anatomical images before and after deformations taking place in the supine breast configuration. The method proposed is workflow-friendly, quantitative, and uses a noncontact, gravity-induced deformation source.
Collapse
Affiliation(s)
- Rebekah H Griesenauer
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Jared A Weis
- Wake Forest School of Medicine, Department of Biomedical Engineering, Winston Salem, North Carolina, United States
| | - Lori R Arlinghaus
- Vanderbilt University Medical Center, Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, United States
| | - Ingrid M Meszoely
- Vanderbilt University Medical Center, Department of Surgery, Nashville, Tennessee, United States
| | - Michael I Miga
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.,Vanderbilt University Medical Center, Vanderbilt University Institute of Imaging Science, Nashville, Tennessee, United States.,Vanderbilt University, Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States.,Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States.,Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, Tennessee, United States
| |
Collapse
|