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Nguyen DL, Greenwood HI, Rahbar H, Grimm LJ. Evolving Treatment Paradigms for Low-Risk Ductal Carcinoma In Situ: Imaging Needs. AJR Am J Roentgenol 2024; 222:e2330503. [PMID: 38090808 DOI: 10.2214/ajr.23.30503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.
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Affiliation(s)
- Derek L Nguyen
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
| | - Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Lars J Grimm
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
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Lee SE, Kim GR, Han K, Kim EH, Kim EK, Kim MJ, Yoon JH, Park VY, Moon HJ. US, Mammography, and Histopathologic Evaluation to Identify Low Nuclear Grade Ductal Carcinoma in Situ. Radiology 2022; 303:276-284. [PMID: 35166586 DOI: 10.1148/radiol.211425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Low nuclear grade ductal carcinoma in situ (DCIS) identified at biopsy can be upgraded to intermediate to high nuclear grade DCIS at surgery. Methods that confirm low nuclear grade are needed to consider nonsurgical approaches for these patients. Purpose To develop a preoperative model to identify low nuclear grade DCIS and to evaluate factors associated with low nuclear grade DCIS at biopsy that was not upgraded to intermediate to high nuclear grade DCIS at surgery. Materials and Methods In this retrospective study, 470 women (median age, 50 years; interquartile range, 44-58 years) with 477 pure DCIS lesions at surgical histopathologic evaluation were included (January 2010 to December 2015). Patients were divided into the training set (n = 330) or validation set (n = 147) to develop a preoperative model to identify low nuclear grade DCIS. Features at US (mass, nonmass) and at mammography (morphologic characteristics, distribution of microcalcification) were reviewed. The upgrade rate of low nuclear grade DCIS was calculated, and multivariable regression was used to evaluate factors for associations with low nuclear grade DCIS that was not upgraded later. Results A preoperative model that included lesions manifesting as a mass at US without microcalcification and no comedonecrosis at biopsy was used to identify low nuclear grade DCIS, with a high area under the receiver operating characteristic curve of 0.97 (95% CI: 0.94, 1.00) in the validation set. The upgrade rate of low nuclear grade DCIS at biopsy was 38.8% (50 of 129). Ki-67 positivity (odds ratio, 0.04; 95% CI: 0.0003, 0.43; P = .005) was inversely associated with constant low nuclear grade DCIS. Conclusion The upgrade rate of low nuclear grade ductal carcinoma in situ (DCIS) at biopsy to intermediate to high nuclear grade DCIS at surgery occurred in more than a third of patients; low nuclear grade DCIS at final histopathologic evaluation could be identified if the mass was viewed at US without microcalcifications and had no comedonecrosis at histopathologic evaluation of biopsy. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Rahbar in this issue.
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Affiliation(s)
- Si Eun Lee
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Ga Ram Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Kyunghwa Han
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Eun Hwa Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Eun-Kyung Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Min Jung Kim
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Jung Hyun Yoon
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Vivian Youngjean Park
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
| | - Hee Jung Moon
- From the Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea (S.E.L., E.K.K.); Department of Radiology, Research Institute of Radiologic Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.R.K., K.H., M.J.K., J.H.Y., V.Y.P.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (E.H.K.); and Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 220-701, Korea (H.J.M.)
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Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology 2021; 302:246-255. [PMID: 34931856 PMCID: PMC8805655 DOI: 10.1148/radiol.211839] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery.
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Affiliation(s)
- Lars J. Grimm
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Habib Rahbar
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Monica Abdelmalak
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Allison H. Hall
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Marc D. Ryser
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
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Anderson S, Parker E, Rahbar H, Scheel JR. IV Ductal Carcinoma In Situ, Including its Histologic Subtypes and Grades. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00439-7] [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]
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Lee SE, Kim HY, Yoon JH, Kim EK, Kim JY, Kim MJ, Kim GR, Park YV, Moon HJ. Chronological Trends of Breast Ductal Carcinoma In Situ: Clinical, Radiologic, and Pathologic Perspectives. Ann Surg Oncol 2021; 28:8699-8709. [PMID: 34196861 DOI: 10.1245/s10434-021-10378-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Because no prior studies have evaluated the chronological trends of ductal carcinoma in situ (DCIS) despite the increasing number of surgeries performed for DCIS, this study analyzed how the clinical, radiologic, and pathologic characteristics of DCIS changed during a 10-year period. METHODS Of 7123 patients who underwent primary breast cancer surgery at a single institution from 2006 to 2015, 792 patients with pure DCIS were included in this study. The chronological trends of age, symptoms, method for detecting either mammography or ultrasonography, tumor size, nuclear grade, comedonecrosis, and molecular markers were calculated using Poisson regression for all patients and asymptomatic patients. RESULTS During 10 years, DCIS surgery rates significantly increased (p < 0.001). Despite the high percentage of DCIS detected on mammography, the detection rate for DCIS by mammography significantly decreased (97.3% in 2006 to 67.6% in 2015; p = 0.025), whereas the detection rate by ultrasound significantly increased (2.7% to 31.0%; p < 0.001). Conservation surgery rates (odds ratio [OR], 1.058), low-to-intermediate nuclear grade rates (OR, 1.069), and the absence of comedonecrosis (OR, 1.104) significantly increased over time (all p < 0.05). Estrogen receptor (ER) negativity (OR, 0.935) and human epidermal growth factor receptor 2 (HER2) positivity rates (OR, 0.953) significantly decreased (all p < 0.05). The same trends were observed for the 613 asymptomatic patients. CONCLUSION The rate of DCIS detected on ultrasound only significantly increased during 10 years. Low-to-intermediate nuclear grade rates significantly increased, whereas ER negativity and HER2 positivity rates significantly decreased during the same period. These findings suggest that DCIS detected on screening ultrasound is less aggressive than DCIS detected on mammography.
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Affiliation(s)
- Si Eun Lee
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jee Ye Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ga Ram Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Youngjean Vivian Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Wu L, Zhao Y, Lin P, Qin H, Liu Y, Wan D, Li X, He Y, Yang H. Preoperative ultrasound radiomics analysis for expression of multiple molecular biomarkers in mass type of breast ductal carcinoma in situ. BMC Med Imaging 2021; 21:84. [PMID: 34001017 PMCID: PMC8130392 DOI: 10.1186/s12880-021-00610-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The molecular biomarkers of breast ductal carcinoma in situ (DCIS) have important guiding significance for individualized precision treatment. This study was intended to explore the significance of radiomics based on ultrasound images to predict the expression of molecular biomarkers of mass type of DCIS. METHODS 116 patients with mass type of DCIS were included in this retrospective study. The radiomics features were extracted based on ultrasound images. According to the ratio of 7:3, the data sets of molecular biomarkers were split into training set and test set. The radiomics models were developed to predict the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67, p16, and p53 by using combination of multiple feature selection and classifiers. The predictive performance of the models were evaluated using the area under the curve (AUC) of the receiver operating curve. RESULTS The investigators extracted 5234 radiomics features from ultrasound images. 12, 23, 41, 51, 31 and 23 features were important for constructing the models. The radiomics scores were significantly (P < 0.05) in each molecular marker expression of mass type of DCIS. The radiomics models showed predictive performance with AUC greater than 0.7 in the training set and test set: ER (0.94 and 0.84), PR (0.90 and 0.78), HER2 (0.94 and 0.74), Ki67 (0.95 and 0.86), p16 (0.96 and 0.78), and p53 (0.95 and 0.74), respectively. CONCLUSION Ultrasonic-based radiomics analysis provided a noninvasive preoperative method for predicting the expression of molecular markers of mass type of DCIS with good accuracy.
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Affiliation(s)
- Linyong Wu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Yujia Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Peng Lin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Hui Qin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Yichen Liu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Da Wan
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Xin Li
- GE Healthcare, Shanghai, People's Republic of China
| | - Yun He
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
| | - Hong Yang
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
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Wang M, Zhao L, Wei Y, Li J, Qi Z, Su N, Zhao C, Zhang R, Tang T, Liu S, Yang F, Zhu L, He X, Li C, Jiang Y, Yang M. Functional photoacoustic/ultrasound imaging for the assessment of breast intraductal lesions: preliminary clinical findings. BIOMEDICAL OPTICS EXPRESS 2021; 12:1236-1246. [PMID: 33796349 PMCID: PMC7984794 DOI: 10.1364/boe.411215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/20/2020] [Accepted: 01/27/2021] [Indexed: 05/18/2023]
Abstract
This study aimed to identify features of breast intraductal lesions in photoacoustic/ultrasound (PA/US) imaging and compare PA/US with color Doppler flow/ultrasound (CDFI/US) in the evaluation of breast intraductal lesions. In the nine patients with 10 breast intraductal lesions and 8 patients with 8 benign lesions, total vessel scores evaluated from PA/US are significantly greater than those from CDFI/US (p=0.005). PA internal vessel scores and oxygen saturation (SO2) score are significantly increased in breast intraductal lesions than in benign lesions (p=0.016, p=0.006). With a cutoff PA score (sum of PA internal vessel score and SO2 score) of 2.5, we obtained a sensitivity of 90% and a specificity of 87.5% in differentiation of two groups. PA/US upgraded 40% of breast intraductal lesions, and downgraded 50% of benign lesions from the Breast Imaging Reporting and Data System grading results based on CDFI/US. PA/US functional imaging has the potential in differentiating breast intraductal lesions.
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Affiliation(s)
- Ming Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingyi Zhao
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Yao Wei
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenhong Qi
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Su
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianhong Tang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Ultrasound, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Sirui Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Yang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Lei Zhu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Xujin He
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Changhui Li
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Mao G, Shi XH, Wang X, Zhang X, Chen X, Ma J, Yu X, Zhang Z, Guo X. Clinicopathological Characteristics of Breast Ductal Carcinoma In Situ: An Analysis of Chinese Population of 617 Patients. JOURNAL OF ONCOLOGY 2021; 2021:8854418. [PMID: 33488713 PMCID: PMC7803394 DOI: 10.1155/2021/8854418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/04/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to describe the clinicopathological characteristics of breast DCIS in Chinese women and compare with that of patients in western countries. METHOD From December 2005 to December 2015, 617 women diagnosed with pure DCIS after surgery at our institution were enrolled, and the clinicopathological characteristics were described. RESULTS In this study, the percentage of patients detected on screening, diagnosed at ≤50 years of age, with tumor size ≤2.0 cm, and with low-intermediate grade was 39.4%, 56.7%, 72.6%, and 77.4%, respectively, as compared to 50-80%, 20-30%, 70-90%, and 40-60% in published reports from western countries. The percentage of ER-positive patients was 76.3% in this study, which is similar to the mean expression rate of ER (mean: 68.7%, range: 49-96.6%) reported previously. CONCLUSIONS The clinicopathological characteristics of Chinese DCIS patients include less detection on screening, younger age at diagnosis, and more low-intermediate nuclear grade.
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Affiliation(s)
- Guangmin Mao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiation Oncology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xiu-hua Shi
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiation Oncology, The No. 2 People's Hospital of Wuhu City, Wuhu, Anhui Province, China
| | - Xiaofang Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomeng Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xingxing Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Koh J, Lee E, Han K, Lee YH, Kwak JY, Yoon JH, Moon HJ. Ultrasonography-Based Radiomics of Screening-Detected Ductal Carcinoma In Situ According to Visibility on Mammography. Ultrasound Q 2020; 37:23-27. [PMID: 33186269 DOI: 10.1097/ruq.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Ductal carcinoma in situ (DCIS) has different prognostic factors according to the detection modality. The purpose of this study was to compare parameters from a radiomic analysis of ultrasonography (US) images for DCIS detected on screening mammography (MMG) and US and detected on screening US only. A total of 154 surgically confirmed DCIS visible on US were included. Regions of interest were drawn onto US images of DCIS, and texture analysis was performed. Lesions were classified into those detected by both US and MMG (the US-MMG group) and those detected by US only (the US group). Analysis parameters were compared between the US-MMG group and the US group. Ninety-six lesions were included in the US-MMG group and 58 lesions in the US group. Energy, entropy, maximum, mean absolute deviation, range, SD, and variance were significantly higher in the US-MMG group than the US group. Kurtosis, skewness, and uniformity were significantly lower in the US-MMG group than the US group. Among the 22 gray-level cooccurrence matrix parameters, 18, 21, 22, 20, and 21 parameters were significantly different between the 2 groups in 0, 45, 90, and 135 degrees and the average value. Among the 11 gray-level run-length matrix parameters, 6, 6, 7, 7, and 6 parameters were significantly different in 0, 45, 90, and 135 degrees and the average value. Inverse variance and gray-level nonuniformity were the most different features between the 2 groups. Screening-detected DCIS showed different radiomic features according to the detection modality.
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Affiliation(s)
- Jieun Koh
- From the Department of Radiology, CHA Ilsan Medical Center, CHA University, Goyang
| | - Eunjung Lee
- Department of Computational Science and Engineering
| | - Kyunghwa Han
- Center for Clinical Imaging Data Science, Department of Radiology
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, Korea
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Ballantyne N, Chen YA, Rabhar H, Grimm LJ. Multimodality Imaging of Ductal Carcinoma In Situ. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-019-00349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Li W, Zhou Q, Xia S, Wu Y, Fei X, Wang Y, Tao L, Fan J, Zhou W. Application of Contrast-Enhanced Ultrasound in the Diagnosis of Ductal Carcinoma In Situ: Analysis of 127 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:39-50. [PMID: 31206200 DOI: 10.1002/jum.15069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore the characteristics of breast ductal carcinoma in situ (DCIS) on real-time grayscale contrast-enhanced ultrasound (CEUS) imaging and the diagnostic value of CEUS in DCIS. METHODS A total of 127 histopathologically confirmed DCIS lesions and 124 fibroadenomas (FAs; controls) were subjected to conventional ultrasound and CEUS. Next, the CEUS findings of DCIS and FA lesions, including morphologic features and quantitative parameters, were analyzed. RESULTS Binary logistic regression was used to identify the independent risk factors from DCIS and FA lesions detected by CEUS. Contrast-enhanced ultrasound revealed significant differences between DCIS and FA. The wash-in time, enhancement mode, enhancement intensity, blood perfusion defects, peripheral high enhancement, enhancement scope, intratumoral vessels and their courses and dilatation degree, and penetrating vessels on CEUS were identified as features correlated with DCIS (P < .05). Moreover, a multivariate logistic regression analysis was developed, and the area under receiver operating characteristic curve of each index was generated, including the wash-in time, enhancement intensity, blood perfusion defects, enhancement scope, penetrating vessels, arrival time, and peak intensity (P < .05; area under the curve, >0.6). CONCLUSIONS The contrast-enhancement patterns and DCIS parameters appeared different from FA lesions, thus suggesting that CEUS can be very useful in distinguishing DCIS from FA lesions.
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Affiliation(s)
- Weiwei Li
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qinghua Zhou
- Departments of Breast Surgery, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shujun Xia
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wu
- Departments of Breast Surgery, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaochun Fei
- Departments of Pathology (X.F.), Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Wang
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingling Tao
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfang Fan
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhou
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Elsaeid YM, Elmetwally D, Eteba SM. Association between ultrasound findings, tumor type, grade, and biological markers in patients with breast cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0048-1] [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
This prospective study included 65 female patients with primary breast cancer. Ultrasound was performed for all patients. Ultrasound findings were analyzed according to the ACR BI-RADS lexicon 5th edition and correlated with tumor type, grade, and biological markers (ER, PR, HER-2/neu, and Ki67). The purpose of this study is to assess the association between ultrasound findings, tumor type, grade, and the state of biological markers in patients with breast cancer.
Results
Irregular shape and speculated margins are more frequently associated with invasive duct carcinoma than DCIS (p value < 0.001). There were no association between the ultrasound findings (shape, margin, orientation, echopattern, and posterior features) and the tumor grade (p value 1.0, 0, 0.544, 1.0, and 1.0), respectively. Irregular shape is more frequently seen in ER and PR positive breast cancers (p value = 0.036 and 0.026, respectively). Non-circumscribed margins were frequently seen in PR positive breast cancers (p value = 0.068). No statistically significant difference between US descriptors and HER-2/neu-positive cases.
Conclusion
Irregularly shaped tumors with speculated margins are frequently seen in invasive duct carcinoma and also more frequently seen in ER-, PR-, and Ki67-positive cases. No relation between ultrasound descriptors and the tumor grade of invasive duct carcinoma. Also, there were no relation between ultrasound descriptors and the state of HER-2/neu.
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Shehata M, Grimm L, Ballantyne N, Lourenco A, Demello LR, Kilgore MR, Rahbar H. Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment. JOURNAL OF BREAST IMAGING 2019; 1:166-176. [PMID: 31538141 DOI: 10.1093/jbi/wbz039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/27/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.
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Affiliation(s)
- Mariam Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA
| | - Lars Grimm
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Nancy Ballantyne
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Ana Lourenco
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Linda R Demello
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Mark R Kilgore
- University of Washington School of Medicine, Department of Anatomic Pathology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
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Fowler AM. Survival Outcomes for Women with Ductal Carcinoma in Situ in the Era of Supplemental Screening. Radiology 2019; 292:49-50. [DOI: 10.1148/radiol.2019190762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amy M. Fowler
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; University of Wisconsin Carbone Cancer Center, Madison, Wis; and Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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