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Wilding M, Fleming J, Moore K, Crook A, Reddy R, Choi S, Schlub TE, Field M, Thiyagarajan L, Thompson J, Berman Y. Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1. Fam Cancer 2023; 22:499-511. [PMID: 37335380 DOI: 10.1007/s10689-023-00340-5] [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] [Received: 11/20/2022] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.Twenty-seven women (30-47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a BRCA pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than BRCA PV carriers (47.3%), which is an independent risk factor for breast cancer.Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable.
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Affiliation(s)
- Mathilda Wilding
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ranjani Reddy
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Sarah Choi
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Field
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jeff Thompson
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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Carmon E, Alster T, Maly B, Kadouri L, Kleinman TA, Sella T. Preoperative MRI for evaluation of extent of disease in IDC compared to ILC. Clin Breast Cancer 2022; 22:e745-e752. [DOI: 10.1016/j.clbc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
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3
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Forrai G, Kovács E, Ambrózay É, Barta M, Borbély K, Lengyel Z, Ormándi K, Péntek Z, Tünde T, Sebő É. Use of Diagnostic Imaging Modalities in Modern Screening, Diagnostics and Management of Breast Tumours 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610382. [PMID: 35755417 PMCID: PMC9214693 DOI: 10.3389/pore.2022.1610382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Breast radiologists and nuclear medicine specialists updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference in Kecskemét. A recommendation is hereby made that breast tumours should be screened, diagnosed and treated according to these guidelines. These professional guidelines include the latest technical developments and research findings, including the role of imaging methods in therapy and follow-up. It includes details on domestic development proposals and also addresses related areas (forensic medicine, media, regulations, reimbursement). The entire material has been agreed with the related medical disciplines.
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Affiliation(s)
- Gábor Forrai
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | - Eszter Kovács
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | | | | | - Katalin Borbély
- National Institute of Oncology, Budapest, Hungary
- Ministry of Human Capacities, Budapest, Hungary
| | | | | | | | - Tasnádi Tünde
- Dr Réthy Pál Member Hospital of Békés County Central Hospital, Békéscsaba, Hungary
| | - Éva Sebő
- Kenézy Gyula University Hospital, University of Debrecen, Debrecen, Hungary
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Sriussadaporn S, Sriussadaporn S, Pak‐art R, Kritayakirana K, Prichayudh S, Samorn P. Ultrasonography increases sensitivity of mammography for diagnosis of multifocal, multicentric breast cancer using 356 whole breast histopathology as a gold standard. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sukanya Sriussadaporn
- Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Suvit Sriussadaporn
- Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Rattaplee Pak‐art
- Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Kritaya Kritayakirana
- Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Supparerk Prichayudh
- Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Pasurachate Samorn
- Department of Surgery, Faculty of Medicine Chulalongkorn University Bangkok Thailand
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Futamura M, Yoshida K. Current status of AYA-generation breast cancer: trends worldwide and in Japan. Int J Clin Oncol 2021; 27:16-24. [PMID: 34921319 DOI: 10.1007/s10147-021-02087-4] [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: 09/26/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
Breast cancer (BC) is the most common cancer worldwide among women. In Japan, the incidence of BC gradually increased. The recent number of adolescent and young adult (AYA)-BC patients is approximately 4,000-5,000 every year, accounting for 5% of all BC cases. BC in young people has been attracting attention since Japan's third basic plan to promote cancer control programs incorporated cancer control measures for pediatric (age ≤ 14 years) and adolescent and young adult (AYA)-generation (age 15-39 years) cancers in 2018. Attention is needed to detect AYA-BC because of the presence of dense breasts. AYA-BC patients are clinically characterized by larger tumor size, more lymph node metastases, advanced stages, and a higher rate of aggressive phenotypes, such as triple-negative or HER2-positive subtypes, and are strongly associated with family history and genetic germline alterations, including hereditary breast and ovarian cancers. Given that AYA-BC patients show a poorer prognosis than older BC patients, they often require intensive therapies, including surgery, radiation, chemotherapy, and endocrine therapy. We must solve many survivorship-associated problems in AYA-BC patients, including fertility preservation, comorbidity after treatment, and long-term follow-up. Under these circumstances, national and local governments and various academic societies have started addressing these problems by formulating laws and guidelines, establishing medical systems, and offering financial support to conquer cancer and maintain a better quality of life. This review summarizes the current trends of AYA-BC worldwide and in Japan. Further Japan-specific data on AYA-BC are required to clarify its characteristics and improve prognosis and survivorship.
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Affiliation(s)
- Manabu Futamura
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kazuhiro Yoshida
- Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Zhu X, Wolfgruber TK, Leong L, Jensen M, Scott C, Winham S, Sadowski P, Vachon C, Kerlikowske K, Shepherd JA. Deep Learning Predicts Interval and Screening-detected Cancer from Screening Mammograms: A Case-Case-Control Study in 6369 Women. Radiology 2021; 301:550-558. [PMID: 34491131 PMCID: PMC8630596 DOI: 10.1148/radiol.2021203758] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The ability of deep learning (DL) models to classify women as at risk for either screening mammography-detected or interval cancer (not detected at mammography) has not yet been explored in the literature. Purpose To examine the ability of DL models to estimate the risk of interval and screening-detected breast cancers with and without clinical risk factors. Materials and Methods This study was performed on 25 096 digital screening mammograms obtained from January 2006 to December 2013. The mammograms were obtained in 6369 women without breast cancer, 1609 of whom developed screening-detected breast cancer and 351 of whom developed interval invasive breast cancer. A DL model was trained on the negative mammograms to classify women into those who did not develop cancer and those who developed screening-detected cancer or interval invasive cancer. Model effectiveness was evaluated as a matched concordance statistic (C statistic) in a held-out 26% (1669 of 6369) test set of the mammograms. Results The C statistics and odds ratios for comparing patients with screening-detected cancer versus matched controls were 0.66 (95% CI: 0.63, 0.69) and 1.25 (95% CI: 1.17, 1.33), respectively, for the DL model, 0.62 (95% CI: 0.59, 0.65) and 2.14 (95% CI: 1.32, 3.45) for the clinical risk factors with the Breast Imaging Reporting and Data System (BI-RADS) density model, and 0.66 (95% CI: 0.63, 0.69) and 1.21 (95% CI: 1.13, 1.30) for the combined DL and clinical risk factors model. For comparing patients with interval cancer versus controls, the C statistics and odds ratios were 0.64 (95% CI: 0.58, 0.71) and 1.26 (95% CI: 1.10, 1.45), respectively, for the DL model, 0.71 (95% CI: 0.65, 0.77) and 7.25 (95% CI: 2.94, 17.9) for the risk factors with BI-RADS density (b rated vs non-b rated) model, and 0.72 (95% CI: 0.66, 0.78) and 1.10 (95% CI: 0.94, 1.29) for the combined DL and clinical risk factors model. The P values between the DL, BI-RADS, and combined model's ability to detect screen and interval cancer were .99, .002, and .03, respectively. Conclusion The deep learning model outperformed in determining screening-detected cancer risk but underperformed for interval cancer risk when compared with clinical risk factors including breast density. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bae and Kim in this issue.
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7
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Jayaratne T, Huang YY, Jacques A, Dhillon R, Porter G, Bose S, Bourke A, Dessauvagie B, Lo G. Is staging breast magnetic resonance imaging prompted upgrade to mastectomy appropriate? ANZ J Surg 2021; 91:1772-1778. [PMID: 33908181 DOI: 10.1111/ans.16887] [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: 09/27/2020] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast magnetic resonance imaging (MRI) use for surgical staging is increasing, though remains controversial. We aimed to evaluate the accuracy of MRI in surgical decision-making to determine if mastectomy prompted by MRI was appropriate. METHODS A single-centre observational study in Perth, Western Australia, with the inclusion of all preoperative and postoperative studies (e.g. involved margins after breast-conserving surgery) undergoing staging breast MRI from 1 January 2015 to 26 August 2019. A standard protocol using gadolinium contrast was used. The reference standard was postoperative histopathology or, for studies without additional surgery after MRI following breast-conserving surgery, the next and subsequent annual screening episodes. By reviewing the final histopathology, the medical case notes and multidisciplinary team decision process, we evaluated whether the reported MRI disease extent was accurate in prompting an appropriate upgrade to mastectomy. Outcomes are reported with descriptive statistics. RESULTS Of 130 cancers staged with MRI; seven were excluded as information was incomplete, 104 were performed preoperatively and 19 postoperatively. The majority (60%) staged lobular carcinoma (invasive 59%, in situ 1%) compared to ductal carcinoma (invasive 31%, in situ 8%). For preoperative MRI, half (54% - 56/104) underwent subsequent mastectomy. Of these, MRI prompted mastectomy in 45% (25/56), all appropriate for disease extent. In the postoperative staging group, two mastectomies were performed, one planned before imaging, the other prompted when MRI diagnosed residual disease and confirmed on histopathology. No false-negative staging MRI was identified. CONCLUSIONS In our cohort, MRI prompted an upgrade to mastectomy in 21% (26/123), appropriate for cancer extent.
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Affiliation(s)
- Thilina Jayaratne
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Yang Yang Huang
- Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Ravinder Dhillon
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreenWA, Perth, Western Australia, Australia
| | - Gareth Porter
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreenWA, Perth, Western Australia, Australia
| | - Sharmistha Bose
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreenWA, Perth, Western Australia, Australia
| | - Anita Bourke
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreenWA, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Ben Dessauvagie
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Anatomical Pathology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.,Anatomical Pathology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Glen Lo
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreenWA, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Medical School, Curtin University, Perth, Western Australia, Australia
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8
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Alaref A, Hassan A, Sharma Kandel R, Mishra R, Gautam J, Jahan N. Magnetic Resonance Imaging Features in Different Types of Invasive Breast Cancer: A Systematic Review of the Literature. Cureus 2021; 13:e13854. [PMID: 33859904 PMCID: PMC8038870 DOI: 10.7759/cureus.13854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/12/2021] [Indexed: 12/04/2022] Open
Abstract
Breast cancer is the most common malignancy affecting women worldwide, and early diagnosis of breast cancer is the key to its successful and effective treatment. Traditional imaging techniques such as mammography and ultrasound are used to detect and configure breast abnormalities; unfortunately, these modalities have low sensitivity and specificity, particularly in young patients with dense breast tissue, breast implants, or post-surgical scar/architecture distortions. Therefore, breast magnetic resonance imaging (MRI) has been superior in the characterization and detection of breast cancer, especially that with invasive features. This review article explores the importance of breast MRI in the early detection of invasive breast cancer versus traditional tools, including mammography and ultrasound, while also analyzing the use of MRI as a screening tool for high-risk women. We will also discuss the different MRI features for invasive ductal carcinoma and lobular carcinoma and the role of breast MRI in the detection of ductal carcinoma in situ with a focus on the utilization of new techniques, including MR spectroscopy and diffusion-weighted imaging.
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Affiliation(s)
- Amer Alaref
- Diagnostic Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Diagnostic Radiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, CAN
- Diagnostic Imaging, Northern Ontario School of Medicine, Sudbury, CAN
| | - Abdallah Hassan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajan Sharma Kandel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rohi Mishra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jeevan Gautam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Cardiology, Rush University Medical Center, Chicago, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Surgical Treatment after Neoadjuvant Systemic Therapy in Young Women with Breast Cancer: Results from a Prospective Cohort Study. Ann Surg 2020; 276:173-179. [PMID: 33378304 DOI: 10.1097/sla.0000000000004296] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to investigate eligibility for breast-conserving surgery (BCS) pre- and post-neoadjuvant systemic therapy (NST), and trends in the surgical treatment of young breast cancer patients. BACKGROUND Young women with breast cancer are more likely to present with larger tumors and aggressive phenotypes, and may benefit from NST. Little is known about how response to NAC influences surgical decisions in young women. METHODS The Young Women's Breast Cancer Study (YWS), a multicenter prospective cohort of women diagnosed with breast cancer at age ≤40, enrolled 1302 patients from 2006 to 2016. Disease characteristics, surgical recommendations, and reasons for choosing mastectomy among BCS-eligible patients were obtained through the medical record. Trends in use of NST, rate of clinical and pathologic complete response (cCR and pCR), and surgery were also assessed. RESULTS Of 1117 women with unilateral stage I-III breast cancer, 315 (28%) received NST. Pre-NST, 26% were BCS eligible, 17% were borderline eligible, and 55% were ineligible. After NST, BCS eligibility increased from 26% to 42% (p < 0.0001). Among BCS-eligible patients after NST (n = 133), 41% chose mastectomy with reasons being patient preference (53%), BRCA or TP53 mutation (35%) and family history (5%). From 2006 to 2016, the rates of NST (p = 0.0012), cCR (p < 0.0001) and bilateral mastectomy (p < 0.0001) increased, but the rate of BCS did not increase (p = 0.34). CONCLUSION While the proportion of young women eligible for BCS increased after NST, many patients choose mastectomy, suggesting that surgical decisions are often driven by factors beyond extent of disease and treatment response.
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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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Soussoko M, Salleron J, Desandes E, Lesur A. [Breast cancer management before 40 years: what change in one decade? A retrospective study at the "Institut de cancérologie de Lorraine": 2002-2012]. Bull Cancer 2020; 106:S60-S74. [PMID: 32008740 DOI: 10.1016/s0007-4551(20)30049-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast cancer of young women has medico-psychological issues, particularly in the perspective of "after cancer" period. The objective of the study was to analyze the changes in management, in a decade including the publication of Cancer Plans I and II. METHODS This retrospective unicentric study involved two populations of women aged 40 and treated at the "Institut de cancérologie de Lorraine" in 2002-2004 (P1) and 2012-2014 (P2). Epidemiological-demographic, histological, diagnostic and therapeutic sequences were analyzed. RESULTS 216 patients were included. The mean age was 35.7 years (range 22-40), with no significant epidemiological difference, except for an increased rate of obesity in P2. Preoperative biopsies became almost systematic and the pre-therapeutic care plan rate increased over the decade from 3.8% to 8% (p < 0.001). The rate of breast-conserving treatment remained stable. The sentinel lymph node rate increased from 4.4% in P1 to 31.9% in P2 (p < 0.001), while the rate of lymph node dissection decreased (p < 0.001) between the two periods. Resort to breast nurses, psycho-oncologists, fertility experts and oncogenetic consultations has also increased. CONCLUSION There is an improvement in the care and management of young women under 40 because of the first Cancer Plans. A study about the impact on the prognosis and a reflection to improve the experience of illness for these women are to lead.
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Affiliation(s)
- Mariam Soussoko
- Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France.
| | - Julia Salleron
- Cellule data biostatistique, Institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Emmanuel Desandes
- Service en charge des données de santé, Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy cedex, France
| | - Anne Lesur
- Institut de cancérologie de Lorraine Alexis-Vautrin, Parcours sein, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
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12
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Li J, Mo Y, He B, Gao Q, Luo C, Peng C, Zhao W, Ma Y, Yang Y. Association between MRI background parenchymal enhancement and lymphovascular invasion and estrogen receptor status in invasive breast cancer. Br J Radiol 2019; 92:20190417. [PMID: 31398071 PMCID: PMC6849688 DOI: 10.1259/bjr.20190417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: In magnetic resonance imaging (MRI), background parenchymal enhancement (BPE) is associated with breast cancer risk, but the associations between BPE and clinical characteristics and histological features are unknown. This study aimed to investigate the association between BPE and clinical characteristics (including age, menopausal status, and tumor histological characteristics) in patients with invasive breast cancer. Methods: This was a retrospective study of 163 patients with invasive breast cancer (164 lesions, 1 patient had bilateral cancer) confirmed by surgery and pathological examination, treated between January 2014 and December 2016 at our university (Kunming Medical University). The patients were divided into two groups: extremely minimal and mild enhancement (low BPE group, n = 78) vs moderate and marked enhancement (high BPE group, n = 86). Results: Compared with the low BPE group, the high BPE group showed higher frequencies of patients < 50 years of age (88% vs 38%, p < 0.0001), premenopausal (87% vs 29%, p < 0.0001), T1 staging (35% vs 15%, p = 0.027), Grade II (57% vs 37%, p = 0.03), lymphovascular invasion (83% vs 13%, p < 0.0001), and positive estrogen receptor (ER) (79% vs 42%, p < 0.0001). The Spearman correlation coefficients (r) between BPE and age, menopausal status, lymphovascular invasion, and ER status were −0.521 (p < 0.0001), –0.588 (p < 0.0001), 0.697 (p < 0.0001), and 0.377 (p < 0.0001), respectively. Conclusion: BPE is negatively associated with age and menopausal status, and is positively associated with lymphovascular invasion and positive ER status. Advances in knowledge: BPE is not correlated with T staging and histological classification in patients with invasive breast cancer.
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Affiliation(s)
- Jun Li
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yin Mo
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Bo He
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Qian Gao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Chunyan Luo
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Chao Peng
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Wei Zhao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yun Ma
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Ying Yang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
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13
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Faermann R, Weidenfeld J, Chepelev L, Kendal W, Verma R, Scott-Moncrieff A, Peddle S, Doherty G, Lau J, Ramsay T, Arnaout A, Lamb L, Watters JM, Seely JM. Outcomes after Surgery for Early Stage Breast Cancer in Women Staged With Preoperative Breast Magnetic Resonance Imaging According to Breast Tissue Density. JOURNAL OF BREAST IMAGING 2019; 1:115-121. [PMID: 38424925 DOI: 10.1093/jbi/wbz018] [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: 01/11/2019] [Indexed: 03/02/2024]
Abstract
PURPOSE To determine surgical outcomes and breast cancer disease-free survival outcomes of women with early stage breast cancer with and without use of preoperative breast MRI according to breast tissue density. METHODS Women with early stage breast cancer diagnosed from 2004 to 2009 were classified into 2 groups: 1) those with dense and heterogeneously dense breasts (DB); 2) those with nondense breasts (NDB) (scattered fibroglandular and fatty replaced tissue). The 2 groups were reviewed to determine who underwent preoperative MRI. Breast tissue density was determined with mammography according to ACR BI-RADS. Patients were compared according to tumor size, grade, stage, and treatment. Survival analysis was performed using Kaplan-Meier estimates. RESULTS In total, 261 patients with mean follow-up of 85 months (25-133) were included: 156 DB and 105 NDB. Disease-free survival outcomes were better in the DB group in patients with MRI than in those without MRI: patients with MRI had significantly fewer local recurrences (P < 0.016) and metachronous contralateral breast cancers (P < 0.001), but this was not the case in the NDB group. Mastectomies were higher in the DB group with preoperative MRI than in those without MRI (P < 0.01), as it was in the NDB group (P > 0.05). CONCLUSIONS Preoperative breast MRI was associated with reduced local recurrence and metachronous contralateral cancers in the DB group, but not in the NDB group; however, the DB patients with MRI had higher mastectomy rates.
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Affiliation(s)
- Renata Faermann
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Jonathan Weidenfeld
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Leonid Chepelev
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Wayne Kendal
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Hospital, Department of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Raman Verma
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Scott-Moncrieff
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Susan Peddle
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Geoff Doherty
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Jackie Lau
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Epidemiology, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Angel Arnaout
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Hospital, Department of Surgery, Ottawa, ON, Canada
| | - Leslie Lamb
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | | | - Jean M Seely
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
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Selvi V, Nori J, Meattini I, Francolini G, Morelli N, Di Benedetto D, Bicchierai G, Di Naro F, Gill MK, Orzalesi L, Sanchez L, Susini T, Bianchi S, Livi L, Miele V. Role of Magnetic Resonance Imaging in the Preoperative Staging and Work-Up of Patients Affected by Invasive Lobular Carcinoma or Invasive Ductolobular Carcinoma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1569060. [PMID: 30046588 PMCID: PMC6038675 DOI: 10.1155/2018/1569060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 01/06/2023]
Abstract
Purpose The prevalence of invasive lobular carcinoma (ILC), the second most common type of breast cancer, accounts for 5%-15% of all invasive breast cancer cases. Its histological feature to spread in rows of single cell layers explains why it often fails to form a palpable lesion and the lack of sensitivity of mammography and ultrasound (US) to detect it. It also has a higher incidence of multifocal, multicentric, and contralateral disease when compared to the other histological subtypes. The clinicopathologic features and outcomes of Invasive Ductolobular Carcinoma (IDLC) are very similar to the ILC. The purpose of our study is to assess the importance of MRI in the preoperative management and staging of patients affected by ILC or IDLC. Materials and Methods We identified women diagnosed with ILC or IDLC. We selected the patients who had preoperative breast MRI. For each patient we identified the areas of multifocal, multicentric, or contralateral disease not visible to standard exams and detected by preoperative MRI. We analyzed the potential correlation between additional cancer areas and histological cancer markers. Results Of the 155 women who met our inclusion criteria, 93 (60%) had additional cancer areas detected by MRI. In 61 women, 39,4% of the overall population, the additional cancer areas were confirmed by US/tomosynthesis second look and biopsy. Presurgical MRI staging changed surgical management in the 37,4% of the patients. Only six patients of the overall population needed a reoperation after the initial surgery. No statistically significant correlation was found between MRI overestimation and the presence of histological peritumoral vascular/linfatic invasion. No statistically significant correlation was found between additional cancer areas and histological cancer markers. Conclusions Our study suggests that MRI is an important tool in the preoperative management and staging of patients affected by lobular or ductolobular invasive carcinoma.
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Affiliation(s)
- Valeria Selvi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Noemi Morelli
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Diego Di Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luis Sanchez
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Tommaso Susini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
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15
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Elder EA, Ferlin A, Vallow LA, Li Z, Gibson TC, Bagaria SP, McLaughlin SA. The Influence of Breast Density on Preoperative MRI Findings and Outcome in Patients with a Known Diagnosis of Breast Cancer. Ann Surg Oncol 2017; 24:2898-2906. [DOI: 10.1245/s10434-017-5981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 11/18/2022]
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16
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Tang W, Hu FX, Zhu H, Wang QF, Gu YJ, Peng WJ. Digital breast tomosynthesis plus mammography, magnetic resonance imaging plus mammography and mammography alone: A comparison of diagnostic performance in symptomatic women. Clin Hemorheol Microcirc 2017; 66:105-116. [DOI: 10.3233/ch-16242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fei-Xiang Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi-Feng Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Jia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei-Jun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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17
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Gweon HM, Jeong J, Son EJ, Youk JH, Kim JA, Ko KH. The clinical significance of accompanying NME on preoperative MR imaging in breast cancer patients. PLoS One 2017; 12:e0178445. [PMID: 28558007 PMCID: PMC5448772 DOI: 10.1371/journal.pone.0178445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/12/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the significance of accompanying NME in invasive ductal carcinoma (IDC) on preoperative MR imaging and assess the factors affecting the significance. Methods Between January 2015 and February 2016, 163 consecutive patients with IDC who underwent preoperative MR imaging and subsequent surgery were enrolled and reviewed. Index cancer mass size and total extent with accompanying NME on MR images was measured and compared with pathologic size. Positive NME was defined as pathological result of IDC or DCIS. To identify affecting factors associated with frequency of accompanying NME on MR and positive pathologic result, clinicopathologic features were compared between breast cancers with NME and without NME, and between breast cancers with positive NME and negative NME using the Student t-test or Chi-square test. Results Of the 163 invasive breast cancers, 123(75.5%) cancers presented as only mass feature and 40(24.5%) cancers had accompanying NME around the index mass. Of the 40 accompanying NME, 22 (55%) had positive pathologic results and 18 (45%) had negative results. The HER2 positive status was significantly associated with positive pathologic results of accompanying NME (P = .016). Conclusion Accompanying NME on preoperative MR imaging showed malignant pathologic results in 55%. The HER2 positive IDC was more frequently accompanied by malignant NME.
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Affiliation(s)
- Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Ko
- Department of Radiology, CHA Bundang Medical Center, CHA University, School of Medicine, Gyeonggi-do, Republic of Korea
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18
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Tseng J, Kyrillos A, Liederbach E, Spear GG, Ecanow J, Wang CH, Czechura T, Kantor O, Miller M, Winchester DJ, Pesce CE, Rabbitt S, Yao K. Clinical accuracy of preoperative breast MRI for breast cancer. J Surg Oncol 2017; 115:924-931. [PMID: 28409837 DOI: 10.1002/jso.24616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/12/2017] [Accepted: 02/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is unclear if breast magnetic resonance imaging (MRI) is more accurate than mammography (MGM) and ultrasound (U/S) in aggregate for patients with invasive cancer. METHODS We compared concordance of combined tumor size and tumor foci between MRI and MGM and U/S combined to pathological tumor size and foci as the gold standard from 2009 to 2015. Tumor size was nonconcordant if it differed from the pathologic size by ≥33% and tumor foci was nonconcordant if >1 foci were seen. If one or both of the MGM or U/S was nonconcordant and the MRI was concordant, MRI provided greater accuracy. RESULTS Of 471 patients with MGM, US, and MRI, MRI was more accurate for 32.9% of patients for tumor size and for 21.9% for tumor foci. Patients for whom MRI had greater accuracy were compared to those who did not for clinical and tumor factors. The only significant factor was calcifications on mammography. Tumor size, stage, molecular subtype, histology, grade, patient BMI, age, mammographic density, and use of hormone replacement therapy were not significantly different. CONCLUSIONS Breast MRI provides greater accuracy for a third of patients undergoing preoperative MGM and U/S. Mammographic calcifications were associated with MRI clinical accuracy for patients with invasive cancer.
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Affiliation(s)
- Jennifer Tseng
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Alexandra Kyrillos
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Erik Liederbach
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Georgia G Spear
- Department of Radiology, NorthShore University Health System, Evanston, Illinois
| | - Jacob Ecanow
- Department of Radiology, NorthShore University Health System, Evanston, Illinois
| | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois
| | - Tom Czechura
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Olga Kantor
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Megan Miller
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - David J Winchester
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Catherine E Pesce
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Sarah Rabbitt
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Katharine Yao
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
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19
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A novel computer-aided diagnosis system for breast MRI based on feature selection and ensemble learning. Comput Biol Med 2017; 83:157-165. [DOI: 10.1016/j.compbiomed.2017.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/25/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022]
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20
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Potential Clinical Applications of 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Mammography in Breast Cancer. Nucl Med Mol Imaging 2016; 51:217-226. [PMID: 28878847 DOI: 10.1007/s13139-016-0446-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/19/2016] [Accepted: 07/29/2016] [Indexed: 01/30/2023] Open
Abstract
The whole-body positron emission tomography (PET)/magnetic resonance (MR) scan is a cutting edge technology providing comprehensive structural information from MR imaging and functional features from PET in a single session. Recent research findings and clinical experience have shown that 18F-fluorodeoxyglucose (FDG) whole-body PET/MR imaging has a diagnostic performance comparable with or superior to that of PET/CT in the field of oncology, including for breast cancer. In particular, FDG PET/MR mammography in the prone position with the breast hanging in a pendant manner can provide more comprehensive information about the metabolism, anatomy, and functional features of a breast lesion than a whole-body PET/MR scan. This article reports on current state-of-the-art PET/MR mammography in patients with breast cancer and the prospects for potential application in the future.
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21
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Zhang H, Tan H, Gao J, Wei Y, Yu Z, Zhou Y. The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery. Exp Ther Med 2016; 12:1275-1278. [PMID: 27588049 PMCID: PMC4998097 DOI: 10.3892/etm.2016.3449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects the success rate of the procedure improving the diagnostic accuracy and therapeutic effects.
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Affiliation(s)
- Huiyu Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Hongna Tan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Wei
- Department of Urology, Henan Province Zhigong Hospital, Zhengzhou, Henan 450002, P.R. China
| | - Zhan Yu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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22
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Tabouret-Viaud C, Botsikas D, Delattre BMA, Mainta I, Amzalag G, Rager O, Vinh-Hung V, Miralbell R, Ratib O. PET/MR in Breast Cancer. Semin Nucl Med 2016; 45:304-21. [PMID: 26050658 DOI: 10.1053/j.semnuclmed.2015.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast cancer is an international public health concern in which an optimal treatment plan requires a precise staging. Both MRI and PET imaging techniques have made significant progress in the last decades with constant improvements that made both modalities clinically relevant in several stages of breast cancer management and follow-up. On one hand, specific breast MRI permits high diagnostic accuracy for local tumor staging, and whole-body MRI can also be of great use in distant staging, eventually accompanied by organ-specific MRI sequences. Moreover, many different MRI sequences can be performed, including functional MRI, letting us foresee important improvements in breast cancer characterization in the future. On the contrary, (18)F-FDG-PET has a high diagnostic performance for the detection of distant metastases, and several other tracers currently under development may profoundly affect breast cancer management in the future with better determination of different types of breast cancers allowing personalized treatments. As a consequence PET/MR is a promising emerging technology, and it is foreseeable that in cases where both PET and MRI data are needed, a hybrid acquisition is justified when available. However, at this stage of deployment of such hybrid scanners in a clinical setting, more data are needed to demonstrate their added value beyond just patient comfort of having to undergo a single examination instead of two, and the higher confidence of diagnostic interpretation of these co-registered images. Optimized imaging protocols are still being developed and are prone to provide more efficient hybrid protocols with a potential improvement in diagnostic accuracy. More convincing studies with larger number of patients as well as cost-effectiveness studies are needed. This article provides insights into the current state-of-the-art of PET/MR in patients with breast cancer and gives an outlook on future developments of both imaging techniques and potential applications in the future.
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Affiliation(s)
- Claire Tabouret-Viaud
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Diomidis Botsikas
- Service de Radiologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Bénédicte M A Delattre
- Service de Radiologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Ismini Mainta
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Gaël Amzalag
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Olivier Rager
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Vincent Vinh-Hung
- Service de Radio-Oncologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Raymond Miralbell
- Service de Radio-Oncologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland; Servei de Radio-Oncologia, Instituto Oncológico Teknon, Barcelona, Spain
| | - Osman Ratib
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland.
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23
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Bansal GJ, Santosh D, Davies EL. Selective magnetic resonance imaging (MRI) in invasive lobular breast cancer based on mammographic density: does it lead to an appropriate change in surgical treatment? Br J Radiol 2016; 89:20150679. [PMID: 26853509 DOI: 10.1259/bjr.20150679] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate whether high mammographic density can be used as one of the selection criteria for MRI in invasive lobular breast cancer (ILC). METHODS In our institute, high breast density has been used as one of the indications for performing MRI scan in patients with ILC. We divided the patients in two groups, one with MRI performed pre-operatively and other without MRI. We compared their surgical procedures and analyzed whether surgical plan was altered after MRI. In case of alteration of plan, we analyzed whether the change was adequate by comparing post-operative histological findings. RESULTS Between 2011 and 2015, there were a total of 1601 breast cancers with 97 lobular cancers, out of which 36 had pre-operative MRI and 61 had no MRI scan. 12 (33.3%) had mastectomy following MRI, out of which 9 (25%) had change in surgical plan from conservation to mastectomy following MRI. There were no unnecessary mastectomies in the MRI group. However, utilization of MRI in this cohort of patients did not reduce reoperation rate (19.3%). Lobular carcinoma in situ (LCIS) was identified in 60% of reoperations on post-surgical histology. Patients in the "No MRI" group had higher mastectomy rate 26 (42.6%), which was again appropriate. CONCLUSION High mammographic density is a useful risk stratification criterion for selective MRI in ILC within a multidisciplinary team meeting setting. Provided additional lesions identified on MRI are confirmed with biopsy, pre-operative MRI does not cause unnecessary mastectomies. Used in this selective manner, reoperation rates were not eliminated, albeit reduced when compared to literature. ADVANCES IN KNOWLEDGE High mammographic breast density can be used as one of the selection criteria for pre-operative MRI in ILC without an increase in inappropriate mastectomies with potential time and cost savings. In this cohort, re-excisions were not reduced markedly with pre-operative MRI.
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Affiliation(s)
- Gaurav J Bansal
- The Breast Centre, University Hospital of Llandough, Penarth, Cardiff, UK
| | - Divya Santosh
- The Breast Centre, University Hospital of Llandough, Penarth, Cardiff, UK
| | - Eleri L Davies
- The Breast Centre, University Hospital of Llandough, Penarth, Cardiff, UK
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24
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The Yield of Pre-operative Breast MRI in Patients According to Breast Tissue Density. Eur Radiol 2015; 26:3280-9. [DOI: 10.1007/s00330-015-4118-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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25
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Rauch GM, Hobbs BP, Kuerer HM, Scoggins ME, Benveniste AP, Park YM, Caudle AS, Fox PS, Smith BD, Adrada BE, Krishnamurthy S, Yang WT. Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence. Ann Surg Oncol 2015; 23:482-9. [PMID: 26416712 DOI: 10.1245/s10434-015-4876-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE This study was designed to determine the relationship of microcalcification morphology and distribution with clinical, histopathologic, biologic features, and local recurrence (LR) in patients with pure ductal carcinoma in situ (DCIS) of the breast. METHODS All patients with pure DCIS who underwent preoperative mammography at our institution from 1996 through 2009 were identified. Mammographic findings were classified according to the ACR BI-RADS lexicon. Associations between mammographic findings and clinical, histopathologic, biologic characteristics, and LR were analyzed. Statistical inference used multiple logistic regression and Cox proportional hazards regression adjusted for age and confounding due to bias from nonrandomized selection of radiation therapy. RESULTS We identified 1657 patients with microcalcifications visualized on mammography. The mean age at diagnosis was 55 years (SD, 11). The mean follow-up was 7 years (range 1-16). Ipsilateral LR was 4 % in segmentectomy (987) and 1.5 % in mastectomy (670) patients. Increased LR risk was seen in patients with dense breast tissue (p < 0.05) and larger DCIS size (p < 0.01). Radiation therapy was associated with a 2.8-fold decrease in the LR risk. Fine linear (branching) microcalcifications were associated with 5.2-fold increase in LR. Extremely dense breast tissue was associated with positive/close margins (p = 0.04) and multicentricity (p < 0.01). Younger women were more likely to have extremely dense breast tissue (p < 0.0001), multicentric disease (p < 0.0004), and undergo mastectomy (p < 0.0001). CONCLUSIONS Dense breast tissue, large DCIS size, and fine linear (branching) microcalcifications were associated with increased LR, yet overall LR rates remained low. Extremely dense breast tissue was a risk factor for multicentricity and positive margins in DCIS.
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Affiliation(s)
- Gaiane M Rauch
- Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Brian P Hobbs
- Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marion E Scoggins
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ana P Benveniste
- Department of Diagnostic Imaging, Unit 1476, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Young Mi Park
- Department of Diagnostic Imaging, Unit 1476, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abigail S Caudle
- Department of Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia S Fox
- Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, Unit 1202, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatriz E Adrada
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Savitri Krishnamurthy
- Department of Pathology Administration, Unit 0053, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei T Yang
- Department of Diagnostic Radiology, Unit 1459, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Biglia N, Ponzone R, Bounous V, Mariani L, Maggiorotto F, Benevelli C, Liberale V, Ottino M, Sismondi P. Role of re-excision for positive and close resection margins in patients treated with breast-conserving surgery. Breast 2014; 23:870-5. [DOI: 10.1016/j.breast.2014.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/22/2014] [Accepted: 09/22/2014] [Indexed: 12/21/2022] Open
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Fayanju OM, Stoll CRT, Fowler S, Colditz GA, Margenthaler JA. Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis. Ann Surg 2014; 260:1000-10. [PMID: 24950272 PMCID: PMC4539958 DOI: 10.1097/sla.0000000000000769] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine whether contralateral prophylactic mastectomy (CPM) is associated with improved survival, incidence of contralateral breast cancer (CBC), and recurrence in patients with unilateral breast cancer (UBC). BACKGROUND Despite conflicting data, CPM rates continue to increase. Here we present the first meta-analysis to assess post-CPM outcomes in women with UBC. METHODS We searched 5 databases and retrieved papers' bibliographies for relevant studies published through March 2012. Fixed- and random-effects meta-analyses were conducted on the basis of tests of study heterogeneity. We examined potential confounding via stratification and meta-regression. We report pooled relative risks (RRs) and risk differences (RDs) with 95% confidence intervals (CIs) at 2-tailed P < 0.05 significance. RESULTS Of 93 studies reviewed, 14 were included in meta-analyses. Compared with nonrecipients, CPM recipients had higher rates of overall survival [OS; RR = 1.09 (95% CI: 1.06, 1.11)] and lower rates of breast cancer-specific mortality [BCM; RR = 0.69 (95% CI: 0.56, 0.85)] but saw no absolute reduction in risk of metachronous CBC (MCBC). Among patients with elevated familial/genetic risk (FGR, ie, BRCA carrier status and/or family history of breast cancer), both relative and absolute risks of MCBC were significantly decreased among CPM recipients [RR = 0.04 (95% CI: 0.02, 0.09); RD = -24.0% (95% CI: -35.6%, -12.4%)], but there was no improvement in OS or BCM. CONCLUSIONS CPM is associated with decreased MCBC incidence but not improved survival among patients with elevated FGR. The superior outcomes observed when comparing CPM recipients with nonrecipients in the general population are likely not attributable to a CPM-derived decrease in MCBC incidence. UBC patients without known FGR should not be advised to undergo CPM.
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Affiliation(s)
- Oluwadamilola Motunaryo Fayanju
- *Department of Surgery †Becker Medical Library, Washington University School of Medicine, St Louis, MO ‡The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
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Lacombe J, Mangé A, Bougnoux AC, Prassas I, Solassol J. A multiparametric serum marker panel as a complementary test to mammography for the diagnosis of node-negative early-stage breast cancer and DCIS in young women. Cancer Epidemiol Biomarkers Prev 2014; 23:1834-42. [PMID: 24957886 DOI: 10.1158/1055-9965.epi-14-0267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The sensitivity of mammography for the detection of small lesions, including node-negative early-stage (T1N0) primary breast cancer (PBC) and ductal carcinoma in situ (DCIS), is significantly decreased in young patients. From a clinical standpoint, an inconclusive mammogram reflects the inability of clinicians to confidently decide whether patients should be referred for biopsy or for follow-up with repeat imaging. METHODS Specific ELISAs were developed for a panel of 13 well-recognized breast autoantigens (HSP60, FKBP52, PRDX2, PPIA, MUC1, GAL3, PAK2, P53, CCNB1, PHB2, RACK1, RUVBL1, and HER2). Circulating autoantibody levels were measured in a cohort of 396 serum samples from histologically confirmed DCIS (n = 87) or T1N0 PBC (n = 153) and healthy controls (n = 156). RESULTS Individually, antibodies against CCNB1, FKBP52, GAL3, PAK2, PRDX2, PPIA, P53, and MUC1 demonstrated discriminatory power between breast cancer and healthy control groups. At 90% sensitivity, the overall combined specificity of the autoantibody serum screening test was 42%. Adjustment for higher sensitivities of 95% and 99% resulted in 30% and 21% specificities, respectively (33% and 18% in T1N0 PBC and 28% and 21% in DCIS). Finally, in patients with node-negative early-stage breast cancer younger than 50 years, the autoantibody assay exhibited 59% specificity with a fixed sensitivity at 90%. CONCLUSIONS Our autoantibody panel allows accurate detection of early breast cancer and DCIS, notably in younger patients. IMPACT Clinical assessment of this autoantibody panel displays a potential to facilitate clinical management of early-stage breast cancer detection in cases of inconclusive mammogram.
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Affiliation(s)
- Jérôme Lacombe
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France
| | - Alain Mangé
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France
| | - Anne-Claire Bougnoux
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France
| | - Ioannis Prassas
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Lunenfeld Tanenbaum Research Institute, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jérôme Solassol
- CHU Montpellier, Arnaud de Villeneuve, Department of Biopathology, Montpellier, France. University of Montpellier I, Montpellier, France. CRLC Val d'Aurelle, Department of Clinical Oncoproteomics, Montpellier, France.
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Houssami N, Turner R, Macaskill P, Turnbull LW, McCready DR, Tuttle TM, Vapiwala N, Solin LJ. An Individual Person Data Meta-Analysis of Preoperative Magnetic Resonance Imaging and Breast Cancer Recurrence. J Clin Oncol 2014; 32:392-401. [DOI: 10.1200/jco.2013.52.7515] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose There is little consensus regarding preoperative magnetic resonance imaging (MRI) in breast cancer (BC). We examined the association between preoperative MRI and local recurrence (LR) as primary outcome, as well as distant recurrence (DR), in patients with BC. Methods An individual person data (IPD) meta-analysis, based on preoperative MRI studies that met predefined eligibility criteria, was performed. Survival analysis (Cox proportional hazards modeling) was used to investigate time to recurrence and to estimate the hazard ratio (HR) for MRI. We modeled the univariable association between LR (or DR) and MRI, and covariates, and fitted multivariable models to estimate adjusted HRs. Sensitivity analysis was based on women who had breast conservation with radiotherapy. Results Four eligible studies contributed IPD on 3,180 affected breasts in 3,169 subjects (median age, 56.2 years). Eight-year LR-free survival did not differ between the MRI (97%) and no-MRI (95%) goups (P = .87), and the multivariable model showed no significant effect of MRI on LR-free survival: HR for MRI (versus no-MRI) was 0.88 (95% CI, 0.52 to 1.51; P = .65); age, margin status, and tumor grade were associated with LR-free survival (all P < .05). HR for MRI was 0.96 (95% CI, 0.52 to 1.77; P = .90) in sensitivity analysis. Eight-year DR-free survival did not differ between the MRI (89%) and no-MRI (93%) groups (P = .37), and the multivariable model showed no significant effect of MRI on DR-free survival: HR for MRI (v no-MRI) was 1.18 (95% CI, 0.76 to 2.27; P = .48) or 1.31 (95% CI, 0.76 to 2.27; P = .34) in sensitivity analysis. Conclusion Preoperative MRI for staging the cancerous breast does not reduce the risk of LR or DR.
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Affiliation(s)
- Nehmat Houssami
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Robin Turner
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Petra Macaskill
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Lindsay W. Turnbull
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - David R. McCready
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Todd M. Tuttle
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Neha Vapiwala
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Lawrence J. Solin
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
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Butler RS, Chen C, Vashi R, Hooley RJ, Philpotts LE. 3.0 Tesla vs 1.5 Tesla breast magnetic resonance imaging in newly diagnosed breast cancer patients. World J Radiol 2013; 5:285-294. [PMID: 24003354 PMCID: PMC3758496 DOI: 10.4329/wjr.v5.i8.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/27/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare 3.0 Tesla (T) vs 1.5T magnetic resonance (MR) imaging systems in newly diagnosed breast cancer patients.
METHODS: Upon Institutional Review Board approval, a Health Insurance Portability and Accountability Act-compliant retrospective review of 147 consecutive 3.0T MR examinations and 98 consecutive 1.5T MR examinations in patients with newly diagnosed breast cancer between 7/2009 and 5/2010 was performed. Eleven patients who underwent neoadjuvant chemotherapy in the 3.0T group were excluded. Mammographically occult suspicious lesions (BIRADS Code 4 and 5) additional to the index cancer in the ipsilateral and contralateral breast were identified. Lesion characteristics and pathologic diagnoses were recorded, and results achieved with both systems compared. Statistical significance was analyzed using Fisher’s exact test.
RESULTS: In the 3.0T group, 206 suspicious lesions were identified in 55% (75/136) of patients and 96% (198/206) of these lesions were biopsied. In the 1.5T group, 98 suspicious lesions were identified in 53% (52/98) of patients and 90% (88/98) of these lesions were biopsied. Biopsy results yielded additional malignancies in 24% of patients in the 3.0T group vs 14% of patients in the 1.5T group (33/136 vs 14/98, P = 0.07). Average size and histology of the additional cancers was comparable. Of patients who had a suspicious MR imaging study, additional cancers were found in 44% of patients in the 3.0T group vs 27% in the 1.5T group (33/75 vs 14/52, P = 0.06), yielding a higher positive predictive value (PPV) for biopsies performed with the 3.0T system.
CONCLUSION: 3.0T MR imaging detected more additional malignancies in patients with newly diagnosed breast cancer and yielded a higher PPV for biopsies performed with the 3.0T system.
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Surgical impact of preoperative breast MRI in women below 40 years of age. Breast Cancer Res Treat 2013; 140:527-33. [DOI: 10.1007/s10549-013-2651-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/20/2013] [Indexed: 10/26/2022]
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Biglia N, Maggiorotto F, Liberale V, Bounous VE, Sgro LG, Pecchio S, D'Alonzo M, Ponzone R. Clinical-pathologic features, long term-outcome and surgical treatment in a large series of patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Eur J Surg Oncol 2013; 39:455-60. [PMID: 23490334 DOI: 10.1016/j.ejso.2013.02.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/15/2013] [Accepted: 02/01/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE OF THE STUDY A retrospective analysis on 1407 patients with invasive ductal carcinoma (IDC) and 243 invasive lobular carcinoma (ILC) was performed in order to compare the histological features, the immunohistochemical characteristics, the surgical treatment and the clinical outcome in the two groups. RESULTS ILC seems to be more likely multifocal, estrogen receptor positive, HER-2 negative and to have a lower proliferative index compared to IDC. ILC, when treated with conservative surgery, required more frequently re-excision and/or mastectomy because of positive resection margins. No difference was observed in terms of 5-year disease free survival and local relapse free survival between the two groups, in the whole series and in the subgroup of patients treated with breast-conserving treatment. CONCLUSION ILC can be safely treated with conservative surgery but a more accurate preoperative evaluation of tumor size and multifocality could be advocated, in order to reduce the re-excision rate.
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Affiliation(s)
- N Biglia
- Academic Division of Gynaecology and Obstetrics, Mauriziano Hospital "Umberto I", University of Turin, Largo Turati 62, Turin, Italy.
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Digital tomosynthesis: a new future for breast imaging? Clin Radiol 2013; 68:e225-36. [PMID: 23465326 DOI: 10.1016/j.crad.2013.01.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 12/19/2022]
Abstract
The aim of this article is to review the major limitations in current mammography and to describe how these may be addressed by digital breast tomosynthesis (DBT). DBT is a novel imaging technology in which an x-ray fan beam sweeps in an arc across the breast, producing tomographic images and enabling the production of volumetric, three-dimensional (3D) data. It can reduce tissue overlap encountered in conventional two-dimensional (2D) mammography, and thus has the potential to improve detection of breast cancer, reduce the suspicious presentations of normal tissues, and facilitate accurate differentiation of lesion types. This paper reviews the latest studies of this new technology. Issues including diagnostic efficacy, reading time, radiation dose, and level of compression; cost and new innovations are considered.
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Molecular imaging in breast cancer. JOURNAL OF ONCOLOGY 2012; 2012:426260. [PMID: 23326265 PMCID: PMC3544284 DOI: 10.1155/2012/426260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 11/25/2022]
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van der Sangen MJC, Scheepers SWM, Poortmans PMP, Luiten EJT, Nieuwenhuijzen GAP, Voogd AC. Detection of local recurrence following breast-conserving treatment in young women with early breast cancer: optimization of long-term follow-up strategies. Breast 2012; 22:351-6. [PMID: 22989668 DOI: 10.1016/j.breast.2012.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/20/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022] Open
Abstract
The detection of a local recurrence (LR) in young women with breast cancer after breast-conserving treatment (BCT) was investigated to compare the impact of different long-term follow-up strategies. Between 1988 and 2005, 937 women aged ≤40 years were treated with BCT for early-stage breast cancer in the southern part of the Netherlands. Up to October 2009, 152 had developed an isolated LR. Information on follow-up visits was available for 124 of them. Fifty-four LRs (44%) were diagnosed within 5 years and 70 (56%) more than 5 years after BCT. Fifty-six LRs (45%) were detected during routine follow-up visits and 68 (55%) presented between two visits. Sixty-six LRs (53%) were diagnosed in patients reporting symptoms. In 31 patients (25%) the LR was found by mammography alone. About a quarter of the LRs was larger than 2 cm in diameter. These results imply that current follow-up strategies for young women with BCT do not guarantee a timely detection of LR.
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Kim BS, Moon BI, Cha ES. A comparative study of breast-specific gamma imaging with the conventional imaging modality in breast cancer patients with dense breasts. Ann Nucl Med 2012; 26:823-9. [DOI: 10.1007/s12149-012-0649-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/07/2012] [Indexed: 11/30/2022]
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Shin HC, Han W, Moon HG, Yom CK, Ahn SK, You JM, Kim JS, Chang JM, Cho N, Moon WK, Park IA, Noh DY. Limited Value and Utility of Breast MRI in Patients Undergoing Breast-Conserving Cancer Surgery. Ann Surg Oncol 2012; 19:2572-9. [DOI: 10.1245/s10434-012-2289-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Indexed: 11/18/2022]
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Papageorgiou K, Chang HSH, Isaacs D, Fiaschetti D, Ang M, Goldberg R. Refining the goals of oculofacial rejuvenation with dynamic ultrasonography. Aesthet Surg J 2012; 32:207-19. [PMID: 22328690 DOI: 10.1177/1090820x11434523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Volume enhancement/restoration addresses a key component of facial aging and plays an increasingly central role in facial rejuvenation. Advancing our understanding of the structure and morphology of facial aging-and the changes that can be induced with currently-available fillers-will optimize treatment and provide a consensus for appropriate selection of agents and procedures. By elucidating anatomic relationships-particularly dynamic relationships-ultrasonography may facilitate the selection and application of rejuvenation agents and procedures such as lower eyelid blepharoplasty with hyaluronic acid reinforcement of the middle lamella and lateral canthal retinaculum, en glove lysis and dermal fat grafting in the retractor plane for lower eyelid retraction, "posterior girdle" effect with high-viscosity fillers for malar festoons, dynamic analysis of hyaluronic acid within the levator plane for upper eyelid retraction, and serial distribution and integration of autologous fat injection in the lower lid compartments. In this article, the authors describe use of dynamic high-resolution ultrasonography as a tool in defining and improving the outcomes of periocular facial rejuvenation.
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Brewster AM, Parker PA. Current knowledge on contralateral prophylactic mastectomy among women with sporadic breast cancer. Oncologist 2011; 16:935-41. [PMID: 21672945 PMCID: PMC3228146 DOI: 10.1634/theoncologist.2011-0022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/17/2011] [Indexed: 01/02/2023] Open
Abstract
The use of contralateral prophylactic mastectomy (CPM) in the U.S. among patients with unilateral invasive breast cancer increased by 150% from 1993 to 2003. Although CPM has been shown to reduce the risk for developing contralateral breast cancer, there is conflicting evidence on whether or not it reduces breast cancer mortality or overall death. The increase in the CPM rate is especially concerning among women with early-stage sporadic breast cancer who have a minimal annual risk for developing contralateral breast cancer, and for many of these women the risk for distant metastatic disease outweighs the risk for contralateral breast cancer. The lack of information about the clinical value of CPM in women with sporadic breast cancer is an important public health problem. This review evaluates current data on the clinical indications for CPM and long-term patient satisfaction and psychosocial outcomes. Gaps in knowledge about the clinical value of CPM, including patient- and physician-related psychosocial factors that influence the decision-making process of CPM among women with sporadic breast cancer, are highlighted.
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Affiliation(s)
- Abenaa M Brewster
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1439, USA.
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