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Yilmaz F, Hacking SM, Donegan L, Wang L, Yakirevich E, Wang Y. In Search of Calcifications : Histologic Analysis and Diagnostic Yield of Stereotactic Core Needle Breast Biopsies. Am J Clin Pathol 2023:7160379. [PMID: 37167599 DOI: 10.1093/ajcp/aqad037] [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: 12/29/2022] [Accepted: 03/16/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Stereotactic core needle biopsy (SCNB) is used in the diagnostic assessment of suspicious mammographic calcifications to rule out breast ductal carcinoma in situ (DCIS). With advances in imaging technology and increased biopsy tissue volume, the detection rate of calcifications and DCIS in SCNB is unclear. METHODS This retrospective study included 916 consecutive SCNBs for calcifications performed on 893 patients in a 2-year period. RESULTS We found the cancer detection rate was 27.1% (DCIS, 23.7%; invasive, 3.4%). The detection rate for calcifications was 74.8% with the standard 3 levels. Additional leveling of calcification-negative cases further increased the detection of both calcifications (to 99.4% of cases) and DCIS (to 32.9% of cases). Lobular neoplasia (LN) was diagnosed in 41 cases. Twenty-five (61.0%) cases of LN were incidental without associated calcification. Of 32 invasive carcinomas detected on SCNB, 87.5% were T1a or less, and calcifications were associated with atypical ductal hyperplasia/DCIS or LCIS. The common benign lesions associated with calcifications were fibrocystic change (32.5%), fibroadenomatous change (30.2%), and columnar cell change and hyperplasia (8.2%). CONCLUSIONS We determined the up-to-date detection rates of calcification and DCIS in SCNB, as well as the common benign and malignant breast lesions associated with calcifications. Additional levels significantly increase the detection rate when standard levels show only stromal or scant/absent calcifications. Lobular neoplasia is often an incidental finding in SCNB for calcifications. When calcifications are present with LN, they are commonly florid, pleomorphic LCIS, or with concurrent invasive carcinoma.
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Affiliation(s)
| | - Sean M Hacking
- Laboratory Medicine Program, University Health Network, Toronto General Hospital, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Linda Donegan
- Diagnostic Imaging, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Vavolizza RD, Dengel LT. Management of Nipple Discharge. Surg Clin North Am 2022; 102:1077-1087. [DOI: 10.1016/j.suc.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role? Clin Imaging 2021; 74:76-83. [PMID: 33454580 DOI: 10.1016/j.clinimag.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/22/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Mammography remains the standard imaging modality for the identification and characterization of breast calcifications. However, its low specificity results in high biopsy rates in cases of suspicious calcifications. OBJECTIVES To evaluate the diagnostic performance of MRI as an additional tool in the assessment of suspicious mammographic calcifications and to identify the enhancement patterns most related to malignancy. METHODS An observational, prospective, cross-sectional, bi-centre study was conducted including consecutive patients with suspicious calcification groups on mammography (BI-RADS® 4 and 5). Anatomopathological results obtained from biopsies were considered the reference standard, and the patients were followed up for at least two years. MRI examinations were interpreted by two radiologists in consensus. The chi-square test was used to evaluate the correlation between MRI features and histological results. The overall diagnostic performance of MRI for malignancy was calculated. RESULTS 162 female patients were included (mean age, 53 years; range 34-82 years), with 163 mammographic lesions, of which 77 (47.2%) were benign, 64 (39.3%) malignant, and 22 (13.5%) precursor lesions on histopathology. Malignant lesions demonstrated a significantly higher presence of enhancement (56/64; 87.5%) than benign lesions (17/77; 22.1%) (p < 0.001). Non-mass enhancement (NME) was the morphology most related to malignant lesions (38/56; 67.9%). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI for malignancy were 81.5%, 87.5%, 77.8%, 71.8%, and 90.5%, respectively. CONCLUSION MRI performed as an adjunct tool allows to increase imaging specificity for malignancy in suspicious calcifications, which may contribute to reduce the need for biopsy.
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Taskin F, Kalayci CB, Tuncbilek N, Soydemir E, Kurt N, Kaya H, Aribal E. The value of MRI contrast enhancement in biopsy decision of suspicious mammographic microcalcifications: a prospective multicenter study. Eur Radiol 2020; 31:1718-1726. [PMID: 32939619 DOI: 10.1007/s00330-020-07265-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the inclusion of breast MRI in radiological assessment of suspicious, isolated microcalcifications detected with mammography. METHODS In this prospective, multicenter study, cases with isolated microcalcifications in screening mammography were examined with dynamic contrast-enhanced MRI (DCE-MRI) before biopsy, and contrast enhancement of the relevant calcification localization was accepted as a positive finding on MRI. Six experienced breast radiologists evaluated the images and performed the biopsies. Imaging findings and histopathological results were recorded. Sensitivity, specificity, NPV, and PPV of breast MRI were calculated and compared with histopathological findings. RESULTS Suspicious microcalcifications, which were detected by screening mammograms of 444 women, were evaluated. Of these, 276 (62.2%) were diagnosed as benign and 168 (37.8%) as malignant. Contrast enhancement was present in microcalcification localization in 325 (73.2%) of the cases. DCE-MRI was positive in all 102 invasive carcinomas and in 58 (87.9%) of 66 DCIS cases. MRI resulted in false negatives in eight DCIS cases; one was high grade and the other seven were low-to-medium grade. The false-negative rate of DCE-MRI was 4.76%. The sensitivity, specificity, PPV, and NPV for DCE-MRI for mammography-detected suspicious microcalcifications were 95.2%, 40.2%, 49.2%, and 93.3%, respectively. CONCLUSIONS In this study, all invasive cancers and all DCIS except eight cases (12.1%) were detected with DCE-MRI. DCE-MRI can be used in the decision-making algorithm to decrease the number of biopsies in mammography-detected suspicious calcifications, with a tradeoff for overlooking a small number of DCIS cases that are of low-to-medium grade. KEY POINTS • All invasive cancer cases and 87.8% of all in situ cancer cases were detected with MRI, showing a low false-negative rate of 4.7%. • Dynamic contrast-enhanced MRI can be used in the decision-making algorithm to decrease the number of biopsies in mammography-detected suspicious calcifications, with a tradeoff for overlooking a small number of DCIS cases that are predominantly low-to-medium grade. • If a decision for biopsy were made based on MRI findings in mammography-detected microcalcifications in this study, biopsy would not be performed to 119 cases (26.8%).
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Affiliation(s)
- Fusun Taskin
- Department of Radiology, Acibadem M.A.A. University School of Medicine, Atakent University Hospital, 34755, Istanbul, Turkey. .,Acibadem M.A.A. University Senology Research Institute, 34457, Sarıyer, Istanbul, Turkey.
| | - Cem Burak Kalayci
- Acibadem M.A.A. University Vocational School of Health Services Department of Diagnostic Radiology, Acibadem M.A.A. University Atakent Hospital, Kucukcekmece, 34303, Istanbul, Turkey
| | - Nermin Tuncbilek
- Department of Radiology, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Efe Soydemir
- Department of Radiology, Pendik Research Training Hospital, Marmara University School of Medicine, Muhsin Yazicioglu Cad 10, Pendik, 34899, Istanbul, Turkey
| | - Nazmi Kurt
- Department of Radiology, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Handan Kaya
- Department of Pathology, Pendik Research Training Hospital, Marmara University, Muhsin Yazicioglu Cad. No: 10, Pendik, 34899, Istanbul, Turkey
| | - Erkin Aribal
- Department of Radiology, Acibadem M.A.A University School of Medicine, 32, Kayisdagi Cad. Atasehir, Istanbul, Turkey.,Acibadem Altunizade Hospital, Breast Center, Tophanelioglu Cad 13, Altunizade, 34662, Istanbul, Turkey
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Ductal Carcinoma In Situ Management: All or Nothing, or Something in between? CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tao WJ, Zhang HX, Zhang LM, Gao F, Huang W, Liu Y, Zhu Y, Bai GJ. Combined application of pharamcokinetic DCE-MRI and IVIM-DWI could improve detection efficiency in early diagnosis of ductal carcinoma in situ. J Appl Clin Med Phys 2019; 20:142-150. [PMID: 31124276 PMCID: PMC6612698 DOI: 10.1002/acm2.12624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Ductal carcinoma in situ (DCIS) is a precursor of invasive ductal breast carcinoma (IDC). This study aimed to use pharamcokinetic dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the early diagnosis of DCIS. METHODS Forty-seven patients, including 25 with DCIS (age: 28-70 yr, mean age: 48.7 yr) and 22 with benign disease (age: 25-67 yr, mean age: 43.1 yr) confirmed by pathology, underwent pharamcokinetic DCE-MRI and IVIM-DWI in this study. The quantitative parameters Ktrans , Kep , Ve , Vp , and D, f, D* were obtained by processing of DCE-MRI and IVIM-DWI images with Omni-Kinetics and MITK-Diffusion softwares, respectively. Parameters were analyzed statistically using GraphPad Prism and MedCalc softwares. RESULTS All low-grade DCIS lesions demonstrated mass enhancement with clear boundaries, while most middle-grade and high-grade DCIS lesions showed non-mass-like enhancement (NMLE). DCIS lesions were significantly different from benign lesions in terms of Ktrans , Kep , and D (t = 5.959, P < 0.0001; t = 5.679, P < 0.0001; and t = 5.629, P < 0.0001, respectively). The AUC of Ktrans , Kep , D and the combined indicator of Ktrans , Kep, and D were 0.936, 0.902, 0.860, and 0.976, respectively. There was a significant difference in diagnostic efficacy only between D and the combined indicator (Z = 2.408, P = 0.016). CONCLUSION DCE-MRI and IVIM-DWI could make for the early diagnosis of DCIS, and reduce the misdiagnosis of DCIS and over-treatment of benign lesions.
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Affiliation(s)
- Wei-Jing Tao
- Department of Nuclear Medicine, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
| | - Hui-Xin Zhang
- Department of Ultrasound, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
| | - Lian-Mei Zhang
- Department of Pathology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Feng Gao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing City, Jiangsu Province, China
| | - Wei Huang
- Department of Radiology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
| | - Yan Liu
- Department of Radiology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
| | - Yan Zhu
- Department of Radiology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
| | - Gen-Ji Bai
- Department of Radiology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an City, Jiangsu Province, China
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Fang J, Shao Y, Su J, Wan Y, Bao L, Wang W, Kong F. Diagnostic value of PD-1 mRNA expression combined with breast ultrasound in breast cancer patients. Ther Clin Risk Manag 2018; 14:1527-1535. [PMID: 30214216 PMCID: PMC6118870 DOI: 10.2147/tcrm.s168531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction This study explored the value of measuring programmed death 1 (PD-1) in peripheral blood, combined with breast ultrasound using the Breast Imaging Reporting and Data System (BI-RADS) classification, for differentiation between benign and malignant breast tumors. Materials and methods We enrolled 113 patients with breast cancer and 66 patients with benign breast tumors who were admitted to Hangzhou First People’s Hospital from September 2014 to August 2017. The mRNA level of PD-1 was detected by quantitative real-time polymerase chain reaction. Results The mRNA levels of PD-1 were significantly higher in the peripheral blood of patients with breast cancer than those in patients with benign breast tumors. The diagnostic sensitivity of PD-1 mRNA expression was 0.805, the specificity was 0.788, and the area under the curve (AUC) was 0.848 (P < 0.001); the sensitivity of breast ultrasound-based BI-RADS classification was 0.752, the specificity was 0.909, and the AUC was 0.906 (P < 0.001); and the combined sensitivity, specificity, and AUC of the two assays were 0.920, 0.879, and 0.938, respectively (P < 0.001). Progesterone receptor-positive breast cancer patients exhibited high levels of PD-1 expression (P < 0.001). Conclusion This study suggests that the measurement of PD-1 combined with breast ultrasound-based BI-RADS classification represents a significant improvement for breast cancer diagnosis compared with diagnoses based on either method alone.
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Affiliation(s)
- Jianhua Fang
- Department of Ultrasonography, Hangzhou First People's Hospital, Hangzhou 310006, People's Republic of China,
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China
| | - Jiezhi Su
- Department of Breast and Chest Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, People's Republic of China
| | - Ying Wan
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, People's Republic of China
| | - Lingyun Bao
- Department of Ultrasonography, Hangzhou First People's Hospital, Hangzhou 310006, People's Republic of China,
| | - Wei Wang
- Department of Ultrasonography, Hangzhou First People's Hospital, Hangzhou 310006, People's Republic of China,
| | - Fanlei Kong
- Department of Ultrasonography, Hangzhou First People's Hospital, Hangzhou 310006, People's Republic of China,
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Chung HW, So Y, Yang JH, Park KS, Yoo YB, Choi N, Kim MY, Kim J, Lee EJ. Adjunctive Breast-Specific Gamma Imaging for Detecting Cancer in Women with Calcifications at Mammography. Ann Surg Oncol 2017; 24:3541-3548. [PMID: 28819909 DOI: 10.1245/s10434-017-6058-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mammography detects calcium deposits sensitively, but the specificity for differentiating malignancy from benign calcifications is low. Thus, we investigated whether adjunctive breast-specific gamma imaging (BSGI) has incremental value for detecting cancer in women with suspicious calcifications detected by mammography, and compared BSGI with adjunctive ultrasonography (US). METHODS The medical records of women without a personal history of breast cancer who underwent mammography for breast evaluation from 2009 to 2014 were reviewed retrospectively. Patients who had calcifications detected by mammography, with a result of Breast Imaging Reporting and Data System (BI-RADS) categories 3-5, underwent adjunctive US and BSGI and were included in this study. A total of 302 breast lesions in 266 women (mean age ± standard deviation 49 ± 9 years) were selected for this study. RESULTS For detecting breast cancer using mammography plus BSGI, the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve with 95% confidence intervals were 94% (91-96), 90% (86-93), 91% (87-94), 94% (90-96), and 0.92 (0.89-0.95), respectively. For mammography plus US, the respective values were 97% (94-98), 51% (46-57), 68% (63-73), 94% (90-96), and 0.74 (0.70-0.78). CONCLUSIONS Adjunctive BSGI had higher specificity than adjunctive US without loss of sensitivity. This finding suggests that adjunctive BSGI may be a useful complementary initial imaging method to improve the detection of breast cancer in women who have calcifications with suspicious morphology at mammography.
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Affiliation(s)
- Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young So
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyoung Sik Park
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Nami Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jayoun Kim
- Research Coordinating Center, Konkuk University Medical Center, Seoul, Korea
| | - Eun Jeong Lee
- Department of Nuclear Medicine, Seoul Medical Center, Seoul, Korea.
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