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Luo J, Tang L, Chen Y, Yang L, Shen R, Cheng Y, Zhang Z, Lv Z, Yuan L, Yang Y, Cheng Y, Bai B, Luo J, Chen Q. A Prospective Multicenter Study on the Additive Value of Contrast-Enhanced Ultrasound for Biopsy Decision of Ultrasound BI-RADS 4 Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1224-1231. [PMID: 38796340 DOI: 10.1016/j.ultrasmedbio.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE The main aim of this study was to determine whether the use of contrast-enhanced ultrasound (CEUS) could improve the categorization of suspicious breast lesions based on the Breast Imaging Reporting and Data System (BI-RADS), thereby reducing the number of benign breast lesions referred for biopsy. METHODS This prospective study, conducted between January 2017 and December 2018, enrolled consenting patients from eight teaching hospitals in China, who had been diagnosed with solid breast lesions classified as BI-RADS 4 using conventional ultrasound. CEUS was performed within 1 wk of diagnosis for reclassification of breast lesions. Histopathological results obtained from core needle biopsies or surgical excision samples served as the reference standard. The simulated biopsy rate and cancer-to-biopsy yield were used to compare the accuracy of CEUS and conventional ultrasound (US). RESULTS Among the 1490 lesions diagnosed as BI-RADS 4 with conventional ultrasound, 486 malignant and 1004 benign lesions were confirmed based on histology. Following CEUS, 2, 395, and 211 lesions were reclassified as CEUS-based BI-RADS 2, 3, and 5, respectively, while 882 (59%) remained as BI-RADS 4. The actual cancer-to-biopsy yield based on US was 32.6%, which increased to 43.4% when CEUS-based BI-RADS 4A was used as the cut-off point to recommend biopsy. The simulated biopsy rate decreased to 73.4%. Overall, in this preselected BI-RADS 4 population, only 2.5% (12/486) of malignant lesions would have been miscategorized as BI-RADS 3 using CEUS-based reclassification. The diagnostic accuracy, sensitivity, and specificity of contrast-enhanced ultrasound reclassification were 57.65%, 97.53%, and 38.35%, respectively. CONCLUSION Our collective findings indicate that CEUS is a valuable tool in further triage of BI-RADS category 4 lesions and facilitates a reduction in the number of biopsies while increasing the cancer-to-biopsy yield.
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Affiliation(s)
- Jun Luo
- Ultrasound Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Lina Tang
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Lichun Yang
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital, Kunming, China
| | - Ruoxia Shen
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital, Kunming, China
| | - Yan Cheng
- Department of Ultrasound, Qujing City First People's Hospital, Qujing, China
| | - Zizhen Zhang
- Department of Ultrasound, Qujing City First People's Hospital, Qujing, China
| | - Zhihong Lv
- Department of Ultrasound, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Lijun Yuan
- Departments of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong Yang
- Departments of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yinrong Cheng
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, China
| | - Baoyan Bai
- Department of Ultrasound, Yanan University Affiliated Hospital, Yan'an, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qin Chen
- Ultrasound Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.
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Ramli Hamid MT, Ab Mumin N, Abdul Hamid S, Ahmad Saman MS, Rahmat K. Abbreviated breast magnetic resonance imaging (MRI) or digital breast tomosynthesis for breast cancer detection in dense breasts? A retrospective preliminary study with comparable results. Clin Radiol 2024; 79:e524-e531. [PMID: 38267349 DOI: 10.1016/j.crad.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To compare the diagnostic performance of abbreviated breast magnetic resonance (AB-MR) imaging (MRI) and digital breast tomosynthesis (DBT) for breast cancer detection in Malaysian women with dense breasts, using histopathology as the reference standard. MATERIALS AND METHODS This was a single-centre cross-sectional study of 115 women with American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BIRADS) breast density C and D on DBT with breast lesions who underwent AB-MR from June 2018 to December 2021. AB-MR was performed on a 3 T MRI system with an imaging protocol consisting of three sequences: axial T1 fat-saturated unenhanced; axial first contrast-enhanced; and subtracted first contrast-enhanced with maximum intensity projection (MIP). DBT and AB-MR images were evaluated by two radiologists blinded to the histopathology and patient outcomes. Diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV]) was assessed. RESULT Of the 115 women, the mean age was 50.6 years. There were 48 (41.7%) Malay, 54 (47%) Chinese, and 12 (10.4%) Indian women. The majority (n=87, 75.7%) were from the diagnostic population. Sixty-one (53.1%) were premenopausal and 54 (46.9%) postmenopausal. Seventy-eight (72.4%) had an increased risk of developing breast cancer. Ninety-one (79.1%) women had density C and 24 (20.9%) had density D. There were 164 histopathology-proven lesions; 69 (42.1%) were malignant and 95 (57.9%) were benign. There were 62.8% (n=103/164) lesions detected at DBT. All the malignant lesions 100% (n=69) and 35.7% (n=34) of benign lesions were detected. Of the 61 lesions that were not detected, 46 (75.4%) were in density C, and 15 (24.6%) were in density D. The sensitivity, specificity, PPV, and NPV for DBT were 98.5%, 34.6%, 66.3%, and 94.7%, respectively. There were 65.2% (n=107/164) lesions detected on AB-MR, with 98.6% (n=68) malignant and 41.1% (39) benign lesions detected. The sensitivity, specificity, PPV, and NPV for AB-MR were 98.5%, 43.9%, 67.2%, and 96.2%, respectively. One malignant lesion (0.6%), which was a low-grade ductal carcinoma in-situ (DCIS), was missed on AB-MR. CONCLUSION The present findings suggest that both DBT and AB-MR have comparable effectiveness as an imaging method for detecting breast cancer and have high NPV for low-risk lesions in women with dense breasts.
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Affiliation(s)
- M T Ramli Hamid
- Department of Radiology, Faculty of Medicine University Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
| | - N Ab Mumin
- Department of Radiology, Faculty of Medicine University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - S Abdul Hamid
- Department of Radiology, Faculty of Medicine University Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
| | - M S Ahmad Saman
- Department of Public Health, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - K Rahmat
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia
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Wang ML, Chang YP, Wu CH, Chen CH, Gueng MK, Wu YY, Chai JW. Prognostic Molecular Biomarkers in Breast Cancer Lesions with Non-Mass Enhancement on MR. Diagnostics (Basel) 2024; 14:747. [PMID: 38611660 PMCID: PMC11011304 DOI: 10.3390/diagnostics14070747] [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: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Clustered ring enhancement (CRE) is a new lexicon for non-mass enhancement (NME) of breast MR in the 5th BIRADS, indicating a high suspicion of malignancy. We wonder if the presence of CRE correlates with expression of prognostic molecular biomarkers of breast cancer. A total of 58 breast lesions, which MRI reported with NME, were collected between July 2013 and December 2018. The patterns of enhancement including CRE were reviewed and the pathological results with expression of molecular biomarkers were collected. The association between MRI NME, pathological, and IHC stain findings were investigated under univariate analysis. A total of 58 breast lesions were pathologically proven to have breast cancer, comprising 31 lesions with CRE and 27 lesions without CRE on breast MRI. The expression of the estrogen receptor (ER) (p = 0.017) and the progesterone receptor (PR) (p = 0.017) was significantly lower in lesions with CRE as compared with those without CRE. The expression of Ki-67 (≥25%) was significantly higher in lesions with CRE (p = 0.046). The lesions with CRE had a lower expression ratio of ER (50.71 ± 45.39% vs. 74.26 ± 33.59%, p = 0.028). Our study indicated that lesions with CRE may possess different features from those without CRE in molecular expression, bearing a more aggressive behavior.
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Affiliation(s)
- Mei-Lin Wang
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
| | - Yu-Pin Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
- Premium Health Examination Center, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
| | - Chen-Hao Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
| | - Chuan-Han Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
| | - Mein-Kai Gueng
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
| | - Yi-Ying Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (M.-L.W.)
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Breast MRI: Clinical Indications, Recommendations, and Future Applications in Breast Cancer Diagnosis. Curr Oncol Rep 2023; 25:257-267. [PMID: 36749493 DOI: 10.1007/s11912-023-01372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW This article aims to provide an updated overview of the indications for diagnostic breast magnetic resonance imaging (MRI), discusses the available and novel imaging exams proposed for breast cancer detection, and discusses considerations when performing breast MRI in the clinical setting. RECENT FINDINGS Breast MRI is superior in identifying lesions in women with a very high risk of breast cancer or average risk with dense breasts. Moreover, the application of breast MRI has benefits in numerous other clinical cases as well; e.g., the assessment of the extent of disease, evaluation of response to neoadjuvant therapy (NAT), evaluation of lymph nodes and primary occult tumor, evaluation of lesions suspicious of Paget's disease, and suspicious discharge and breast implants. Breast cancer is the most frequently detected tumor among women around the globe and is often diagnosed as a result of abnormal findings on mammography. Although effective multimodal therapies significantly decline mortality rates, breast cancer remains one of the leading causes of cancer death. A proactive approach to identifying suspicious breast lesions at early stages can enhance the efficacy of anti-cancer treatments, improve patient recovery, and significantly improve long-term survival. However, the currently applied mammography to detect breast cancer has its limitations. High false-positive and false-negative rates are observed in women with dense breasts. Since approximately half of the screening population comprises women with dense breasts, mammography is often incorrectly used. The application of breast MRI should significantly impact the correct cases of breast abnormality detection in women. Radiomics provides valuable data obtained from breast MRI, further improving breast cancer diagnosis. Introducing these constantly evolving algorithms in clinical practice will lead to the right breast detection tool, optimized surveillance program, and individualized breast cancer treatment.
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Coşkun Bilge A, Aydın H, Bostancı IE, Tanişman Ö, Saygılı Öz D. Comparison of the Magnetic Resonance Imaging Findings of Paget's Disease of the Breast and Malignant Tumor Invasion of the Nipple-Areola Complex. Eur J Breast Health 2021; 17:265-273. [PMID: 34263155 DOI: 10.4274/ejbh.galenos.2021.6091] [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: 10/26/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022]
Abstract
Objective We aimed to investigate the distinction between Paget's disease of the breast (PDB) and malignant tumor invasion of nipple-areolar complex (MTION) with Magnetic resonance imaging (MRI) findings without the need for skin punch biopsy. Materials and Methods MRI findings of 16 patients with pathologically proven PDB and 11 patients with pathologically proven MTION were reviewed retrospectively. MRI images were assessed for nipple morphological changes; areolar-periareolar skin changes; thickness, classification, and kinetic characteristics of the nipple-areolar complex (NAC) enhancement; morphological pattern, size, and pathological diagnosis of concomitant malignant lesions; kinetic characteristics of the concomitant malignant lesions enhancement; continuity of enhancement between the nipple and closest concomitant malignant lesion; similarity of enhancement kinetics of the NAC and concomitant malignant lesions; and nipple-to-malignant lesion distance in both patient groups. Results Areolar-periareolar skin thickening was statistically different between the patient groups. Enhancement kinetic pattern was classified as persistent in four patients with MTION and plateau in seven patients with PDB. Moreover, NAC enhancement kinetic characteristics were statistically different between the groups. Invasive ductal carcinoma was detected in three patients with PDB and five patients with MTION. A statistically significant difference in malignant lesion pathological types was detected between the patient groups. Conclusion The significant MRI findings in patients with MTION diagnosed as invasive ductal carcinoma were areolar-periareolar skin thickening and asymmetric NAC enhancement with persistent kinetics pattern. In patients diagnosed with ductal carcinoma in situ, a plateau pattern of asymmetric NAC enhancement without any areolar-periareolar skin changes on MRI may indicate PDB.
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Affiliation(s)
- Almila Coşkun Bilge
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hale Aydın
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Işıl Esen Bostancı
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Özge Tanişman
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Diba Saygılı Öz
- Department of Radiology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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