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Kandil NMM, Hashem LMB, Gareer SWY, Hashem AMB. Accuracy of different sonomammographic imaging modalities in assessment of breast tumor size. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00804-1] [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
Accurate breast cancer size is crucial for staging and an important prognostic factor in patient management. Therapeutic decisions heavily depend on tumor size detection by radiological imaging. The purpose of our prospective comparative study is to compare the diagnostic accuracy of different sonomammographic breast imaging modalities, namely DM, DBT, CESM, 2D US and 3D US in the preoperative tumor size measurement.
Results
CESM, 3D US and 2D US achieved moderately strong correlation with the pathological size measurements, while (DM) and (DBT) showed fair correlation with the pathology. CESM showed the highest correlation coefficient (0.789), while (DBT) showed the lowest correlation coefficient (0.411). Regarding the agreement, there was good agreement of the size measured by CESM, 3D US and 2D US with the pathology as the ICC was (0.798), (0.769) and (0.624), respectively. The highest agreement with the pathology was achieved with CESM. The agreement of the size measured by (DM) and (DBT) with the pathology was moderate as the ICC was (0.439) and (0.416), respectively. The lowest agreement was achieved with the size measured by (DBT).
Conclusions
CESM and 3D US are more superior to DM, 2D US and DBT regarding preoperative size measurement. 3D US can be used as preoperative noninvasive technique, especially in patients with impaired renal function who cannot tolerate CESM.
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Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2021; 302:568-581. [PMID: 34904875 DOI: 10.1148/radiol.211412] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% vs 94%, P < .001) and specificity (81% vs 71%, P = .03) compared with recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies in patients with dense breasts, while in 10 studies on mammography-detected suspicious findings, CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusion Contrast-enhanced mammography demonstrated high performance in breast cancer detection, especially with joint interpretation of low-energy and recombined images. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bahl in this issue.
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Affiliation(s)
- Andrea Cozzi
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Veronica Magni
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Moreno Zanardo
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Simone Schiaffino
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Francesco Sardanelli
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
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Hashem LMB, Abd El Hamid NO, Kamal RM, Mansour SM, Lasheen S, Tohamey YM. Does contrast-enhanced mammography have an impact on the detection of cancer in patients with risk of developing breast cancer? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background
Contrast-enhanced mammography (CEM) has been discovered to be more sensitive and specific than two-dimensional full-field digital mammography (FFDM) in both screening and diagnostic settings. The aim of the study was to assess the additive role of CEM in the detection and characterization of breast lesions in women with increased risk of developing breast cancer. This prospective study included 283 female patients with increased risk of developing breast cancer (i.e., positive family history of breast cancer, personal history of breast cancer, and heterogeneously dense mammary parenchyma) coming for either screening (n = 127/283 (49.1%)) or diagnostic (n = 156/283 (55.1%)) purpose. All patients had FFDM and CEM done, and the findings were evaluated independently; final Breast Imaging Reporting And Data System (BIRADS) classification was given for each modality. Results were then compared with histopathology or ultrasound findings with routine follow-up for normal and typically benign findings.
Results
In this study, 283 women with mean age of 48 were enrolled. Among the studied cases regardless to a specific risk factor, 15/283 (5.3%) were diagnosed as normal, 13/283 (4.6%) as inflammatory lesions, 72/283(25.4%) as benign lesions, 6/283 (2.1%) as benign precancerous lesions, and 177/283 (62.5%) as malignant. The overall sensitivity and specificity of the CEM were 92.7 and 71.43 %, respectively, while FFDM were 80.90 and 59.05%, respectively.
Conclusion
Contrast-enhanced mammography is a valuable screening and diagnostic imaging modality in patients with increased risk of developing breast cancer with diagnostic indices higher than mammography resulting in a significantly higher cancer detection rate.
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Haggag MA, Hamed ST, Mawas ASAEL. Primary breast edema on contrast-enhanced digital mammography: a preliminary experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00585-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary breast edema can cause marked increase in skin thickness, breast density and echogenicity due to dense breast tissue filled with fluid and so causes subsequent significant attenuation of both the x-ray and ultrasound beams. The study aim is to assess the value of contrast-enhanced digital mammography (CEDM) in assessment and characterization of the obscured underlying breast lesions in cases of primary breast edema.
Results
Fifty five female participants were evaluated, of median age 51 years old and IQR 21. CEDM shows high sensitivity and specificity in the lesion detection as well as local extension delineation in cases associated with primary breast edema. It was accurate in detection of multifocal/multi-centric disease. CEDM is considered as a good negative test in cases of metastatic axillary lymph nodes to exclude and assess any associated obscured breast lesions, as it is good in delineating breast masses obscured by condensed parenchymal tissue. The calculated sensitivity of DM & CEDM was 87.5%, 95.8%, specificity was 55.5%, 72%, the PPV and NPV were 91, 93.6% and 45%, 77.8%, respectively.
Conclusions
CEDM has an important additional diagnostic value in the assessment, characterization and better delineation of breast lesions in primary edematous breast cases.
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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.
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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
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Suter MB, Pesapane F, Agazzi GM, Gagliardi T, Nigro O, Bozzini A, Priolo F, Penco S, Cassano E, Chini C, Squizzato A. Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. Breast 2020; 53:8-17. [PMID: 32540554 PMCID: PMC7375655 DOI: 10.1016/j.breast.2020.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%-91%], with a sensitivity of 85% [95% CI 73%-93%], and a specificity of 77% [95% CI 60%-88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.
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Affiliation(s)
| | - Filippo Pesapane
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Giorgio Maria Agazzi
- University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Tania Gagliardi
- Department of Radiology, Royal Marsden Hospital, London, UK.
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
| | - Anna Bozzini
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Francesca Priolo
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Silvia Penco
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Enrico Cassano
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Claudio Chini
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
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Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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Moustafa AFI, Kamal EF, Hassan MM, Sakr M, Gomaa MMM. The added value of contrast enhanced spectral mammography in identification of multiplicity of suspicious lesions in dense breast. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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ElSaid NAE, Mahmoud HG, Salama A, Nabil M, ElDesouky ED. Role of contrast enhanced spectral mammography in predicting pathological response of locally advanced breast cancer post neo-adjuvant chemotherapy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kariyappa KD, Gnanaprakasam F, Anand S, Krishnaswami M, Ramachandran M. Contrast enhanced dual energy spectral mammogram, an emerging addendum in breast imaging. Br J Radiol 2016; 89:20150609. [PMID: 27610475 DOI: 10.1259/bjr.20150609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the role of contrast-enhanced dual-energy spectral mammogram (CEDM) as a problem-solving tool in equivocal cases. METHODS 44 consenting females with equivocal findings on full-field digital mammogram underwent CEDM. All the images were interpreted by two radiologists independently. Confidence of presence was plotted on a three-point Likert scale and probability of cancer was assigned on Breast Imaging Reporting and Data System scoring. Histopathology was taken as the gold standard. Statistical analyses of all variables were performed. RESULTS 44 breast lesions were included in the study, among which 77.3% lesions were malignant or precancerous and 22.7% lesions were benign or inconclusive. 20% of lesions were identified only on CEDM. True extent of the lesion was made out in 15.9% of cases, multifocality was established in 9.1% of cases and ductal extension was demonstrated in 6.8% of cases. Statistical significance for CEDM was p-value <0.05. Interobserver kappa value was 0.837. CONCLUSION CEDM has a useful role in identifying occult lesions in dense breasts and in triaging lesions. In a mammographically visible lesion, CEDM characterizes the lesion, affirms the finding and better demonstrates response to treatment. Hence, we conclude that CEDM is a useful complementary tool to standard mammogram. Advances in knowledge: CEDM can detect and demonstrate lesions even in dense breasts with the advantage of feasibility of stereotactic biopsy in the same setting. Hence, it has the potential to be a screening modality with need for further studies and validation.
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Affiliation(s)
- Kalpana D Kariyappa
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Francis Gnanaprakasam
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Subhapradha Anand
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Murali Krishnaswami
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
| | - Madan Ramachandran
- Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India
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